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California is suing two Christian anti-abortion nonprofits over a disputed treatment the groups call “abortion pill reversal” in a case that could reshape the nation’s ongoing battle over abortion rights.
An Alameda County judge heard six weeks of arguments in the case, and will ultimately decide whether the First Amendment shields two anti-abortion groups that promote a disputed hormone treatment, or whether their claims violate false advertising laws.
Attorney General Rob Bonta filed the complaint against Heartbeat International, Inc., a national anti-abortion group, and RealOptions Obria, a chain of Northern California anti-abortion clinics, in 2023 for promoting “abortion pill reversal” services.
The state’s lawyers argue there is no way to reverse a medication abortion and that the treatment touted by the groups is unproven and potentially dangerous. The state is seeking $20 million in penalties under California’s false advertising and unfair competition laws.
Heartbeat International and RealOptions counter that thousands of women bore healthy children after using their services and that their work is protected speech. Heartbeat runs the Abortion Pill Rescue Network, a hotline that connects callers with local providers who give patients high-dose progesterone in an attempt to counteract the abortion pill. Heartbeat has more than 90 affiliates in California, including RealOptions.
Deputy Attorney General Erica Connolly accused the groups of taking advantage of “individuals in emotional turmoil.”
“Those individuals need accurate information, but accurate information is not what the defendants provide,” she said. “Instead, they tout false hope.”
Defendants contend that “abortion pill reversal” services are free, so false advertising law doesn’t apply.
Defense attorney Paul Jonna said the state cannot prove anyone was harmed by the services and called it an “an ideological campaign disguised as consumer fraud prosecution.”
A federal appeals court reached a similar conclusion in a New York case, finding that the state’s false advertising law did not apply because “abortion pill reversal” was not commercial speech
What is “abortion pill reversal?”
Medication abortion typically involves two drugs, mifepristone and misoprostol, taken 24 to 48 hours apart. Mifepristone blocks progesterone, a hormone needed to sustain pregnancy, while misoprostol causes the uterus to contract, expelling its contents similar to a miscarriage, according to the American College of Obstetricians and Gynecologists, the nation’s leading maternal health medical group. Nearly two-thirds of all abortions are medication abortions, the Guttmacher Institute reports.
Heartbeat and its affiliates claim mifepristone’s effects can be counteracted by high doses of progesterone. The group says more than 8,000 pregnancies nationwide have continued after clients have taken additional progesterone, claiming a success rate between 64% to 68%.
Jonna said defense witnesses, including women who sought to reverse their abortions, testified that they never felt “harmed, deceived or misled,” and that no consumer has ever filed a complaint against the groups.
The state argues the groups should not be allowed to make definitive statements about the safety or effectiveness of “abortion pill reversal” when there is no credible scientific evidence to support it. The two studies most often cited by reversal proponents have been dismissed by medical groups, including the American College of Obstetricians and Gynecologists and New England Journal of Medicine, as having very little merit.
“They are welcome to talk about (“abortion pill reversal”). They’re just not allowed to lie about it,” Connolly said.
Taking both pills safely ends pregnancy 95% to 98% of the time, according to the American College of Obstetricians and Gynecologists and multiple independent studies. Those who take only the first pill and not the second will continue pregnancy about 50% of the time.
California’s struggle to regulate anti-abortion clinics
RealOptions is a crisis pregnancy center, typically a religiously affiliated organization opposed to abortion that may offer clinical services like ultrasounds and pregnancy tests. Crisis pregnancy centers outnumber abortion clinics in California more than five to one.
Critics say they mislead women who are seeking abortions. Supporters say they offer an alternative to women with unplanned pregnancies.
California has struggled to regulate the centers. In 2018, the U.S. Supreme Court struck down a state law requiring reproductive health centers, including crisis pregnancy centers, to notify clients about abortion and birth control options, and requiring unlicensed centers to tell clients they were not medical facilities. The court found the law violated the First Amendment’s freedom of speech protections.
Reproductive rights scholar Mary Ziegler, who is not involved in the litigation, said the outcome hinges on how the speech is classified. The First Amendment protects different kinds of speech to varying degrees.
“Is it political and religious speech? Is it commercial speech, which enjoys less protection? Is it just conduct?” she said, adding that crisis pregnancy centers are a legal gray area, because they present themselves as religious advocacy organizations while often behaving like medical providers.
The 2nd U.S. Circuit Court of Appeals sided with defendants in the New York case, ruling that “abortion pill reversal” statements were protected under the constitution because they are “religiously and morally motivated.”
Last month, a Kansas state district court judge struck down several anti-abortion restrictions, including a requirement for abortion providers to talk about “abortion pill reversal” with patients, finding that the law violated women’s right to bodily autonomy under state law partially because they were forced to listen to “unproven” statements.
Ziegler said even if California loses its “abortion pill reversal” case, abortion rights advocates might still count it as a long-term win.
“If the world we live in says, you know, you have a protected right to tell patients things that are potentially dangerous to them, then that’s going to raise public concerns anyway,” she said.
Judge Patrick McKinney has three months to make a ruling.
Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.
