For the overwhelming majority of people who choose to end their pregnancies, actually getting an abortion prompts a feeling of relief. By one week post-abortion, a 2020 study found that 97.5 percent of women reported that their abortion was the right decision. By five years post-abortion, the share of women reporting their decision was right rises to 99 percent.
A woman who doubts the rightness of her decision, however, might seek relief at RealOptions Obria Medical Clinics, a nonprofit operating across the San Francisco Bay Area that claims to provide “abortion pill reversal” services. According to the organization’s website, RealOptions clinics “offer no-cost, confidential [abortion pill reversal] treatment” for patients who have only taken the first pill of the standard two-pill abortion medication regimen.
There is one big problem with this offer: Abortion reversal is not a real thing. The American College of Obstetricians and Gynecologists warns that “so-called abortion ‘reversal’ procedures” are “unproven and unethical,” and that claims regarding their efficacy are “not based on science” and “do not meet clinical standards.”
In 2023, California Attorney General Rob Bonta brought a lawsuit against RealOptions and an affiliated anti-abortion organization, alleging violations of state laws against false advertising and fraudulent business practices. Yet throughout the three-month trial, which wrapped in September, the organizations contended that their claims were constitutionally protected speech. RealOptions argued that the First Amendment prohibits the government from punishing their promotion of “free, religiously motivated information” as if it were “ordinary commercial fraud.” The trial judge is expected to issue a ruling before the end of the year.
Posturing as a medical provider and marketing snake oil to vulnerable people is not a constitutional right. But the case against RealOptions is not the first time that anti-abortion activists have marshaled free speech arguments in order to continue misleading pregnant patients. And when they did so before, the strategy received a stamp of approval from the Republican justices on the Supreme Court.
Back in 2015, California enacted a law requiring “crisis pregnancy centers” to disclose whether they were licensed to provide medical services, and to notify patients that California has real programs providing abortion care and other reproductive healthcare. Anti-abortion activists sued and asked federal courts to block the law while the case was pending. The lower courts denied the requests, but in the 2018 case National Institute of Family and Life Advocates v. Becerra, the Supreme Court reversed. Justice Clarence Thomas wrote for the five-justice majority that California did not present a “persuasive reason” for treating “professional speech” as “exempt from ordinary First Amendment principles.”
In NIFLA, the Supreme Court demonstrated that it is willing to protect a First Amendment right to harm patients seeking care, so long as the people inflicting the harm use their words. And it demonstrated that willingness again in Chiles v. Salazar, a constitutional challenge to a Colorado law banning state-licensed counselors from providing “conversion therapy” to minors. Lower courts upheld the statute, recognizing it as a public health law that protected children against harmful conduct in the guise of “treatment.” But in March 2026, the Supreme Court reversed. Justice Neil Gorsuch wrote for the eight-justice majority that the conversion therapy ban “censors speech based on viewpoint,” and instructed the lower court to apply more “rigorous” scrutiny under the First Amendment.
Against this backdrop, anti-abortion activists are refining their litigation strategies, and invoking the First Amendment to constitutionalize their attacks on bodily autonomy. In 2024, for example, anti-abortion activists won a federal court order in New York blocking the state from enforcing its false advertising laws against crisis pregnancy centers offering “abortion pill reversals.” In 2025, anti-abortion activists won another federal court order in Colorado, similarly blocking a law that banned doctors and nurses from providing “reversals” on First Amendment grounds. Earlier this year, Colorado agreed to settle the lawsuit for over $6 million.
Over the past decade, the Supreme Court has read into the First Amendment a constitutional right to deceive vulnerable people, and to frustrate their attempts to make informed decisions over their bodies and futures. Anti-abortion activists have seized the opportunity.
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