Prescribing progesterone to pregnant women who changed their minds after trying to have a medical abortion is up to the doctor’s clinical judgement, Health Minister Chris Fearne has said.

This comes after pro-choice doctors cried foul over leaflets advertising “abortion reversal” appeared in a faculty magazine at the University of Malta.

Fearne was replying to a question by independent MP Rosianne Cutajar, who cited the abortion reversal advert in her question and asked whether such a procedure is legal in Malta.

Fearne replied that progesterone use is legal “when used according to the judgement of the doctor treating the patient”.

An advertising poster that features abortion pill reversal.

Last week, pro-choice group Doctors for Choice highlighted an advertisement by the crisis pregnancy centre, Life Line Malta, which appeared in a University of Malta faculty publication, and which claimed it could help students “reverse” the effects of abortion pills.

On their website, Life Line Malta says that they can refer pregnant women to a care provider who will provide them with progesterone after taking the first dose of the abortion pill.

But Doctors for Choice say that such treatment has been denounced by international medical bodies and could have “serious side effects” on women.

How is it supposed to work?

Medical abortions, which are illegal in Malta, take place through a two-part medication regime, usually through ingesting pills.

These are Mifepristone, which works to block the hormone progesterone, followed by Misoprostol, which is supposed to be taken 24 hours later. Misoprostol then induces labour leading to the pregnancy being terminated.

In general, medical abortions are intended to be taken by women who have been pregnant for 12 weeks or less.

Abortion is illegal in Malta but may be performed by a doctor if a woman’s life is in immediate risk or in grave jeopardy which may lead to death.

According to Life Line Malta, should a person change their mind about continuing with an abortion after taking Mifepristone, administering a high dose of progesterone can “block” the effects of the first drug.

In comments to Times of Malta, Mater Dei’s head of Obstetrics and Gynaecology Yves Muscat Baron said that locally, progesterone is used to reduce miscarriages and treat threatened miscarriages “without any complications or risk”.

He added that studies on abortion reversal are limited because as a procedure it has only been undertaken relatively recently.

One case control study, which compared taking progesterone to a placebo after Mifepristone, was abandoned after two patients in the placebo group and one in the progesterone group required urgent hospitalisation due to bleeding.

Another observational study following 754 patients who took progesterone after Mifepristone found there are no apparent increased risks of birth defects.

“This study concluded that ‘reversal of the effects of mifepristone using progesterone is safe and effective’,” he said.

However, in a statement, Doctors for Choice said that the American College of Obstetricians said that abortion reversal treatments are “not based on science and do not meet clinical standards”.

Referring to the first study, which they said enrolled 12 participants, they said this was ended because three people required ambulance transport to the hospital for severe haemorrhage.

“This indicates that this treatment could be a serious hazard to the health of women,” Doctors for Choice said.

Other bodies such as the Royal College of Obstetricians and Gynaecologists, the Faculty of Sexual and Reproductive Healthcare and the Royal College of Midwives have also said there is no “reputable evidence” that progesterone can be used to reverse an abortion, they said.

“We consider it inappropriate that the highest educational institution in Malta would carry an advertisement for this unlicensed, deceptive, and potentially hazardous treatment,” they continued.

“This has nothing to do with giving space to differing views on abortion. This is a case of advertising a treatment that has been denounced by the highest international authorities in obstetrics and gynaecology and could have real negative effects on vulnerable students at the University of Malta,” they added.