Reproductive Health and Misinformation

Reproductive health and misinformation

In the wake of the U.S. Supreme Court’s Dobbs decision, many healthcare providers continue to struggle with what these changes mean for their role in reproductive health. In an environment full of so many unknowns, it’s no surprise to see reproductive health misinformation thrive. Regardless of veracity, competing information regarding procedures and medications can travel quickly on the internet, leading to confusion, uncertainty, and doubt.  

Here are some recurring claims related to reproductive health, pregnancy, and abortions. 

Recommended podcast: Women’s Reproductive Health Issues in the Face of Changing Legislation

Mifepristone and progesterone 

A progesterone antagonist, mifepristone is one of the medications indicated in a medical abortion. It fills progesterone receptors, leaving the progesterone naturally occurring in pregnancy unable to maintain the pregnancy. 

Debates over state and federal laws regulating the prescription and sale of mifepristone are currently ongoing. In some states, however, a provider is legally required to share information claiming that giving progesterone can reverse the pharmacologic mechanism of mifepristone and reverse a medication abortion.  

There is limited research to support this claim. In one study that administered very high doses of intramuscular progesterone by injection to six women who had taken mifepristone, four of the six successfully carried the pregnancies to term.  

However, a single key study doesn’t provide enough scientific evidence to support this practice.  

Vitamins, herbs, and alcohol 

Another circulating myth involves self-induced abortion using vitamins, herbs, or alcohol intoxication. Patients hoping to end pregnancy have tried vitamin C, parsley, dong quai, rose hips, ginger root, chamomile, black cohosh, and lots of pineapple. They might also try pain medications like analgesics, illicit drugs, antibiotics, birth control pills, and caffeine pills. 

While many early healers in the 1800s may have relied on such mechanisms, there are no reliable studies or significant data to demonstrate the safety or effectiveness of these methods in ending a pregnancy. Some are downright dangerous. Though a substance may be teratogenic or cause birth defects, it doesn’t necessarily mean that it will be effective in ending the pregnancy, and it may risk significant harm to the mother. 

Black market and international pills 

If they don’t think they can obtain medications legally, some patients may turn to black market options. Not only is this practice dangerous, but it may also violate both United States and international laws.  

In many states, the U.S. Food and Drug Administration-approved medications mifepristone and misoprostol can be purchased through telehealth and/or appropriate regulated websites. This approval is currently under review in the Supreme Court. 

However, there are international companies who will sell and ship similar drugs to the United States. These medications coming from other countries are not evaluated by the FDA, which means the contents are not regulated according to U.S. standards. In fact, the FDA has specific warnings regarding obtaining mifepristone from other countries.  

The FDA’s online resource, BeSafeRX, can help guide consumers in identifying safe online pharmacies in the U.S., not only for abortion medications, but for all pharmaceuticals. 

Self-managed abortions 

Most people both inside and outside the healthcare profession have heard stories of self-managed abortions: those that succeeded, as well as those that went tragically wrong. The term “self-managed abortion” does not necessarily mean illegal or unsafe. In some states, given access to abortion medications through telehealth and legitimate online pharmacies, patients may self-manage medication abortions if they desire. 

Without access to approved medications, however, patients turning to alternative “home remedies” may face severe injury or death. Historical data suggests that those with the fewest resources are most likely to attempt some type of physical means of ending pregnancy, such as inserting an object into the vagina or the uterus.  

Physical attempts to end a pregnancy carry the greatest long-term risk. Inserting objects that pass through the non-sterile vagina into the sterile uterus can cause an infection that could lead to sepsis, uterine scarring, future fertility issues, even death. 

Additional complications could include hemorrhaging or excessive bleeding. If the patient is in a state in which abortions are illegal or strictly regulated, they may delay seeking care for fear of prosecution, further risking their health. 

Ectopic and non-viable pregnancy 

After the release of the Dobbs decision, many patients and providers worried that the legislation would not provide abortion exceptions for ectopic pregnancies and other life-threatening conditions.   

Both executive orders and statements from the U.S. Department of Health and Human Services have ensured providers that they are protected when providing emergency care to patients with dangerous medical conditions related to pregnancy.  

Some states have further clarified their laws to take this into consideration. These new definitions state that ‘abortion’ does not describe a procedure to remove a pregnancy that is spontaneously incapable of continuing to term in cases where their provider believes the mother’s life to be in jeopardy.  

Even so, this adds an extra level of emergency decision-making for healthcare professionals working in a highly regulated state. 

Dangers and risks 

Another common myth is that elective abortions carry no dangers or risks. While many patients may have had abortions managed by medical providers and healed, many other patients report infertility issues or uterine scarring, particularly after surgical abortions.  

There are risks and dangers to every medical intervention, as well as risks associated with forgoing some medical interventions. In a medicated abortion, common side effects include gastrointestinal upset, nausea, cramping, bleeding. Infections can still occur, and there remains a chance that the abortion fails, and the patient remains pregnant. 

In a procedural abortion, risks include perforation of the uterus and laceration or physical damage to the cervix. Each of these complications occur in less than 1% of procedures. However, there is also the risk of infection and bleeding. 

After the uterus is instrumented with any type of curetting procedure, long-term risks include the formation of synechiae, or little scar tissues. This may or may not affect future fertility.  

Another potential complication correlating to abortion procedures like dilation and evacuation (D&E) is called Asherman’s. In this rare condition, buildup of adhesions in the uterus can cause pain, changes in menstrual patterns, and fertility issues later in the patient’s life. 

Mental and emotional health 

Decisions touching reproduction and pregnancy can be life-altering, with impacts on a patient’s emotional and mental health. Though most states do not allow advanced practice nurses to independently provide abortions, nursing professionals are nevertheless responsible for providing their patients with the best care based on their health needs.  

According to the American Nurses Association, nurses must provide their patients with comprehensive and unbiased education as to all options about sexual and reproductive health. However, “Nurses have the right to refuse to participate in sexual reproductive healthcare (SRC) care based on ethical grounds, as long as patient safety is assured, and alternative sources of care have been arranged.” (ANA, 2022) 

Education and advocacy 

Nurses play a huge role in education and advocacy. As the nation continues to feel the ripples of Dobbs, preventing unintended pregnancies becomes an absolute priority for healthcare educators. 

Despite shifting legislation, reproductive health misinformation, and heightened political rhetoric around issues of SRC, nurses continue to care for their patients with respect, competence, and compassion.