The Markup has found that Facebook is serving up ads and posts for the so-called “abortion pill reversal” procedure, a medically unapproved and potentially dangerous process that the American College of Obstetricians and Gynecologists says is “not based on science.”
Facebook has been circulating this content for years, a practice that both lawmakers and anti-disinformation advocates have publicly criticized. But it’s especially controversial now as interest in medication abortion has spiked with the recent Supreme Court decision overturning Roe v. Wade and resulting physical clinic closures.
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We found 17 ads from two anti-abortion activist groups circulated on Facebook from October through March. We collected that data through our Citizen Browser project, which gathers posts and group recommendations served to a national panel of Facebook users. Meta’s own ad library showed another group’s abortion reversal ad was live on the platform in May. And regular unpaid Facebook posts pushing the procedure also appeared in our Citizen Browser data as recently as June.
The ads appear to be addressed to people experiencing unwanted pregnancies who have just begun the two-step process of a medication abortion: one dose of mifepristone, which ends the pregnancy by blocking production of the natural hormone progesterone, and one of misoprostol, which induces contractions similar to a miscarriage. They encourage people who have taken the first pill to skip the second half and instead flood their bodies with progesterone, a hormone that promotes fetal growth, in an attempt to halt the process.
Many of the posts list a toll-free number and website for a 24/7 help line that can connect callers with a physician to prescribe the progesterone. One website linked from an ad states that this “reversal” can be effective up to 72 hours after someone has taken the first pill and that the treatment has a “64-68% success rate.” It lists mild side effects, including sleepiness and lightheadedness.
Medical experts say that there’s no evidence that the procedure works and that its potential side effects can be life-threatening.
An issue brief by the University of California San Francisco Medical Center noted that the touted success rates come from three reports that were very limited, had no control groups, and lacked oversight by an ethics committee. “A systematic review of literature on the topic concluded in 2015 that there is no credible evidence that abortion ‘reversal’ improves the chances of continuing pregnancy,” it reads. The American College of Obstetricians and Gynecologists states that the procedure is “unproven and unethical.”
Aside from efficacy, a study of the procedure’s safety at the University of California, Davis, had to be stopped before it was complete because three of the test subjects were hospitalized for severe hemorrhaging, although the reasons are unclear. All three of the women took only the first half of the two-drug abortion pill regimen and skipped the second; then two took a placebo and one took progesterone.
“All we could say was that there’s something from a safety standpoint going on—we don’t know exactly what it is—but it wasn’t safe to continue the study in otherwise healthy subjects,” said Dr. Mitchell Creinin, a professor of obstetrics and gynecology at UC Davis, who led the study and is an expert on contraception and medication abortion. He added that perhaps a future study may provide more clarity. In the meantime, however, he says that “this treatment is unproven for both efficacy and safety” and that “every leading medical organization has said this is bogus.”
In 2019, the American Medical Association filed a lawsuit in U.S. District Court in North Dakota to block a new state law that would require doctors to tell patients that a medication abortion may be reversed and where to get it done. The AMA called it an “experimental and unethical treatment” and “a patently false and unproven claim unsupported by scientific evidence.” The case is ongoing.
At the time, North Dakota was one of eight states that had passed similar “compelled speech” laws. In its court complaint, the AMA argued that the legislative trend is “unmoored from medical science.”
Meta says in its advertising policies that it prohibits ads that make misleading health claims, as well as ads containing content that’s been debunked by experts on that topic. At the same time, recent media reports suggest that Facebook and Instagram have been removing users’ posts about the distribution and availability of abortion pills themselves—and even banning accounts that create those posts—since the Supreme Court’s ruling last month overturning Roe v. Wade.
A Meta spokesperson’s statement explained that Facebook wasn’t allowing posts involving the sale or gifting of pharmaceuticals; but critics said the company’s policy toward abortion-related content is confusing and unevenly enforced.
Meta did not reply to multiple emails and direct messages to a spokesperson on Twitter requesting comment.
Meta’s policy decisions are particularly relevant now. Because medication abortions only require a prescription and a mailing address, they currently exist in a rapidly changing legal gray area. Reproductive health advocates say this will make it an even more confusing environment for people trying to educate themselves and access health services in a timely way. Medication abortions now account for more than half of all abortions in the U.S., according to a report this year.
Citizen Browser panelists saw multiple abortion pill reversal advertisements paid for by two anti-abortion activist organizations: Heartbeat International and Live Action.
Andrea Trudden, Heartbeat International’s vice president of communications, told The Markup that abortion pill reversal is indeed safe and effective, and that the organization fields questions about this debate so often that it has a page on its website devoted to it.
She claimed in an email that “[t]housands of women have been able to save their pregnancies and give birth to healthy children thanks to abortion pill reversal.” Trudden and others claim that UC Davis’s safety study showed the procedure was effective because in four of the five cases where progesterone was administered after taking the first abortion pill, a fetal heartbeat was detected two weeks later. However, Creinin said that because the study was halted early, there were not enough subjects for a statistical analysis on efficacy.
Live Action and the advertiser appearing in Meta’s ad library, RETA Pregnancy Clinic & Family Resources, did not respond to requests for comment from The Markup.
The text of one Live Action ad tells the story of “Shashana”: “Pregnant and abandoned by her baby’s father, Shashana took the abortion pill. She immediately regretted it and called Planned Parenthood—but they denied her help. Thankfully, she didn’t give up trying to save her baby and discovered the Abortion Pill Reversal Hotline. With the help of trained doctors, she was able to save her baby boy.”
Another Live Action ad has a close-up picture of a fetus and text that reads, “On day one, a baby’s DNA, gender, ethnicity, hair color, and eye color are determined. This is human development in the first 10 weeks of life. Did you know it is possible to reverse the abortion pill?” This ad was targeted toward women Meta had marked as interested in “pregnancy” and “motherhood.” When a Citizen Browser panelist saw it in early March, this ad had already been shared 36,000 times.
Facebook has allowed ads on this topic for years. Google used to serve them up as well, but an advocacy group called the Center for Countering Digital Hate (CCDH) said Google removed the ads after the center published a report last September criticizing both Facebook and Google for targeting the ads to “children between the ages of 13 and 17.”
In a statement to news organizations at the time, Facebook said “most of the ads were inactive or months or years old” and “many” had been removed for violating “our policies around offering adult products and services.” It did not address whether it would continue serving the ads to adults.
According to our Citizen Browser data, the abortion pill reversal ads are not targeting minors on Facebook but rather adults. It is not clear whether these targeting choices were made by Facebook or the advertisers.
“It’s incredibly disappointing, and also dangerous, that platforms have continued a pattern of inaction on this,” said Sarah Eagan, chief of staff at CCDH, in a recent interview. “These are known tactics used by anti-choice groups to leverage misinformation when people are at a point of vulnerability, searching for information that should be accurate about the choices that they may need to make.”
She says CCDH now wants Meta to donate its profits from ads about abortion pill reversal to reproductive health organizations. She also says the company owes it to its users to develop a process to let people know that they’ve been exposed to misinformation and direct them toward better sources that have been vetted by medical experts.
“There’s never been a more high-stakes time to crack down on misinformation around abortion and abortion access,” said Eagan. “This is really just a plea to Meta to do the right thing here.”
Lawmakers are also taking note. In February of this year, Rep. Jerrold Nadler, chairman of the House Judiciary Committee, sent a letter to Meta asking why Facebook was continuing to promote content about a medical procedure known to be dangerous. It also asked for documentation of the steps the company had taken and would take in the future to prevent the spread of abortion-related misinformation.
In a March 11 letter responding to Nadler, Meta defended its decision to run the ads: “[O]ur rules related to misinformation, prescription drugs, or coordinating harm may apply to content about abortion,” its response read, in part. It noted that ads that advocate on the topic of abortion require prior authorization.
“However,” the letter went on, “discussing controversial topics or espousing a debated point of view is not at odds with our Community Standards…. Meta allows posts and ads promoting legal health care services like abortion, as well as discussion and debate around abortion.”
This article was copublished with STAT, a national publication that delivers trusted and authoritative journalism about health, medicine, and the life sciences. Sign up for its health tech newsletter, delivered Tuesday and Thursday mornings, here: https://www.statnews.com/signup/health-tech/.