SACRAMENTO — California Attorney General Rob Bonta is asking an Alameda County judge to impose $20 million in penalties on two anti-abortion nonprofits accused of misleading people about an unproven treatment known as “abortion pill reversal.” The seven-week trial in Oakland focused on Heartbeat International and RealOptions, organizations that promote giving progesterone to patients who have taken mifepristone, the first drug in a medication abortion. State attorneys argued that the treatment has not been shown to work or be safe and that marketing it as a way to halt an abortion violates California’s false-advertising and unfair-competition laws. The nonprofits’ lawyers countered that the claims are protected religious speech. They also argued that the groups provide the service without charge and that the state failed to prove the treatment is ineffective. Closing arguments are scheduled for next week. Alameda County Superior Court Judge Patrick McKinney is expected to rule within three months. The case is among the first major legal challenges to both the medical claims behind abortion-pill reversal and the role of crisis pregnancy centers, which seek to discourage abortion and now outnumber abortion clinics nationally. A ruling against the groups could limit how such centers describe experimental treatments and expose them to significant financial penalties. A ruling for the nonprofits could strengthen their ability to characterize abortion-related services as religious speech. Medication abortion generally involves mifepristone, which blocks progesterone and stops a pregnancy from developing, followed 24 to 48 hours later by misoprostol, which causes uterine contractions. Abortion-reversal providers say a large dose of progesterone taken after mifepristone can counteract the drug’s effects. Heartbeat International operates a hotline that connects callers with providers and says more than 8,000 abortions have been reversed, with a success rate of nearly 70 percent. California attorneys challenged those figures, saying they do not establish whether pregnancies would have continued without progesterone and lack basic safeguards such as control groups and random sampling. Major medical organizations, including the American College of Obstetricians and Gynecologists, say the treatment has not been adequately studied. A 2012 study frequently cited by supporters involved only six patients, had no control group and did not receive ethics review. A 2019 study was stopped early after several participants required emergency treatment for heavy bleeding. “ The evidence at trial showed that Defendants made unsupported claims about abortion pill reversal that targeted vulnerable Californians,” Walter Garcia, a spokesperson for Bonta, said in a statement. “We want to stop these deceptive practices and make sure that people facing deeply personal healthcare decisions have accurate information.” The attorney general’s office alleges that RealOptions, which runs five California centers, made more than 125 unlawful statements and that Heartbeat International made nearly 4,000. The requested penalties are based on that tally. The Thomas More Society, which represents the nonprofits, argued that a randomized study withholding progesterone from some participants would be unethical. Its attorneys also cited anecdotal reports of successful reversals and said the groups’ motives are religious rather than commercial. Crisis pregnancy centers vary widely. Some employ licensed medical professionals, while others rely primarily on faith-based counseling, and many are not subject to the same rules as conventional medical clinics. A federal estimate put the number of such centers operating nationwide last year at roughly 2,400 to 2,800, although the lack of a standard definition makes the total difficult to verify. Their influence has grown since the U.S. Supreme Court overturned the constitutional right to abortion in 2022. Lawmakers in 32 states introduced more than 100 bills this year involving funding, legal protections or oversight of the centers. Separately, state laws requiring doctors to tell abortion patients that a medication abortion can be reversed have faced constitutional challenges from medical providers and others who say the mandates compel them to deliver medically unsupported information.