The latest social media misinformation: Abortion reversal pills

Social media companies are grappling with a flood of misinformation on an unexpected topic since Roe v. Wade was overturned: Posts promoting “abortion reversal pills.”

The dangerous and unproven treatment is being touted as a way for a pregnant person to halt a medication abortion before it can take effect. And while claims about these pills have existed on social media for years, they’re now skyrocketing — and getting a lot more traction with users.

A POLITICO analysis of abortion-reversal content across the major social media platforms showed engagement — such as liking, reposting or commenting — increased significantly after the Dobbs decision. Facebook, for example, saw a dramatic spike of 3,500 interactions with “abortion reversal pill” content on June 24 — the day of the Supreme Court decision — up from 20 interactions on June 23, according to data compiled using CrowdTangle, a social media analysis tool.

This type of content falls into a gray area in many social media platforms’ policies about how to handle misinformation — one where definitive research doesn’t exist and the level of danger is unclear. As a result, they’re struggling to find the right approach and sometimes allowing abortion-reversal content even as they block posts about how to obtain medication abortions.

It’s a predicament that highlights the unique challenges facing companies from Facebook to Twitter and YouTube as they try to moderate mistruths about abortion on their sites without inserting themselves into a highly politicized debate.

Misinformation researchers say the increase in abortion reversal content appears to be sowing doubt and confusion online, muddying the waters around the effectiveness of medication abortions, which pregnant people can still obtain through the mail even in states that have banned the procedure.

“Mis- and disinformation is really designed to confuse you in that situation and make it more about the ideological arguments and conspiracies in a way to cloud your judgment about how easy or safe it is to access an abortion,” said Rachel Moran, a postdoctoral scholar at the University of Washington’s Information School studying health misinformation.

The posts allege that these abortion reversal treatments — which involve giving an individual progesterone after ingesting the first pill (mifepristone) in the two-pill medication abortion treatment — will stop the abortion. Websites and hotlines touting abortion reversal said progesterone is given as a pill, though it has been researched as an injection. Mifepristone blocks the flow of progesterone needed to support a pregnancy, and misoprostol causes cramping which expels the biological tissue.

The National Right to Life Committee — one of largest anti-abortion-rights groups — stands behind the alleged treatment and says women deserve to know it’s an option.

But the American College of Obstetricians and Gynecologists, the nation’s leading organization of reproductive health clinicians, has said the reversal treatment is not supported by science and can cause dangerous hemorrhaging. And a 2019 trial evaluating abortion reversal treatment with progesterone ended early due to three participants experiencing high levels of internal bleeding.

Dr. Mary Jacobson, chief medical officer of Alpha Medical, a women’s health telemedicine group that is in the process of adding medication abortion as a service, called the progesterone treatment “an unproven and unethical idea that suggests a flawed oversimplification of how complex hormonal and neurochemical processes of a medication abortion can be manipulated.”

However, to date, federal health agencies like the Food and Drug Administration and the Centers for Disease Control and Prevention haven’t weighed in on the safety or efficacy of administering progesterone as a way to reverse a medication abortion, making it more challenging for platforms to navigate the disinformation without a federal authoritative voice to cite. An FDA spokesperson said it has not approved any abortion reversal pill products.

Abortion reversal pill content is just one subset of misinformation spreading online as debates about the Dobbs decision proliferate on social media. Other false content from anti-abortion groups includes posts saying the FDA-approved medication abortion causes cancer and infertility, even though medication abortion has been proven to be safer than Tylenol. And on the abortion-rights side, individuals are spreading misinformation about at-home herbal treatments to induce abortion, which can be potentially poisonous.

Overall, the largest platforms have removed more content related to potentially dangerous herbal treatments from abortion rights groups, and less content about abortion reversal treatments from anti-abortion groups, said Jenna Sherman, a program manager at Meedan’s Digital Health Lab, a global tech non-profit focused on health misinformation research.

“It’s good that any posts about natural remedies for abortion are being regulated, but it's concerning that they're being overly regulated in comparison to anti-choice rhetoric, which is also very harmful,” she said.

The largest social media platforms have taken different approaches to moderating the onslaught of mistruths about abortion. ByteDance’s TikTok and Google’s YouTube have instituted new policies to specifically combat content promoting unsafe abortion procedures and false claims about abortion treatments. 

TikTok’s medical misinformation policy prohibits content that can physical harm, and that includes abortion reversal and herbal abortion content, spokesperson Jamie Favazza said. But enforcement has been uneven. POLITICO identified videos promoting abortion reversal hotlines and alleged reversal treatment testimonials and flagged them to TikTok, which later took them down because they violated its policies, Favazza said.

The company had blocked all content related to the search for “herbal abortions” earlier this year and in August blocked searches related to the search terms “abortion pill reversal” and “abortion reversal pill,” after POLITICO identified videos on the topic. However, the search term “abortion reversal” is still unblocked because it also includes content related to the overturning Roe v. Wade, Favazza said. However, the results also include videos pushing abortion reversal pill content, which TikTok removed after POLITICO flagged them.

YouTube started removing videos in July that provided instructions for unsafe abortions or promoted false claims about abortion safety under its medical misinformation policies. Those included videos incorrectly claiming abortion leads to cancer or infertility. It also prohibits videos that sell pharmaceuticals without a prescription, which would include abortion reversal pills. And YouTube added “context labels” to abortion content that links to the National Library of Medicine’s description of abortion.

However, YouTube allows general discussion of abortion reversal treatments. Spokesperson Ivy Choi said the company will look to CDC, NIH, and WHO if they set guidance on such alleged treatments. YouTube has also added labels to posts by pregnancy crisis centers — which counsel pregnant people against abortion and sometimes push abortion reversal pills — to note that they don’t provide abortions.

Twitter allows discussion of abortion — including abortion reversal content — but is using its Twitter Moments and Events pages to promote authoritative information and dispel misleading narratives, spokesperson Elizabeth Busby said.

Meta, parent company of Facebook and Instagram, bans the promotion of medical misinformation if it is shown to cause harm, along with the sale of pharmaceutical drugs. Ads promoting prescription drugs also require pre-approval (including those that cause abortions) and must come from verified pharmaceutical companies, pharmacies or telehealth providers.

Still, two ads promoting an abortion pill reversal hotline from anti-abortion groups were active on Facebook as of Friday afternoon. A Facebook spokesperson said the ads were allowed since they didn’t mention a pharmaceutical drug — like progesterone — by name. Meanwhile, Plan C, an advocacy organization that provides resources on medication abortion, showed POLITICO multiple ads on how to obtain medication abortion pills that Facebook rejected. The Facebook spokesperson said the ads were blocked because the landing page of websites on the ads listed pharmaceutical abortion drugs by name.

Some of the surge of abortion-reversal content online may be connected to efforts by abortion rights groups to debunk it.

People’s engagement with all sort of abortion posts on social media platforms tends to increase after new restrictions on abortion go into effect, said Rachel Muller Heyndyk, a senior fact checker at the U.K. based Logically.ai. As the conversation gains momentum, content from anti-abortion groups promoting abortion reversal pills gets swept up in it.

“The more we engage with it, even if it is to criticize it, the more we'll see it on our feed,” said Muller Heyndyk. She said because Facebook isn’t deciding whether abortion reversal content is dangerous or not, “it is inadvertently rewarding those pages.”

For example, the week after Texas’ six-week abortion ban went into effect last September, there were 170,000 interactions on abortion reversal pill content on Facebook compared to fewer than 200 interactions the month prior, according to CrowdTangle data.

If the social media companies are waiting for more guidance from the federal government on how to treat information about abortion reversal procedures, it may be awhile.

While FDA chief Robert Califf has promised to make tackling health misinformation a priority, the agency has so far put more resources into countering falsehoods on Covid-19 and monkeypox. The agency launched a new website in early August called “Rumor Control” that tackles those two diseases, but doesn’t address abortion misinformation.