The 'abortion pill'
A victory but not a
cure-all
By
Ellen Catalinotto
Certified Nurse-Midwife
New York
On
Sept. 28 the Food and Drug Administration approved the marketing of RU486, the
"abortion pill" sought for many years by advocates of women's reproductive
rights. Since these abortion-inducing pills could be dispensed from any doctors'
offices, this could help end the isolation of abortion clinics, which have
become targets of right-wing attacks by anti-abortion
forces.
Those
who are pro-choice welcome this drug's legalization, which expands the options
and enhances the privacy of women seeking to end an unwanted pregnancy. But they
should be aware that it will be no magic cure-all for those wanting to guarantee
the right of women to reproductive
freedom.
There
are many battles ahead to make RU486 legally available and financially
accessible to those who want it. But it may not be the appropriate way to
terminate unwanted pregnancy in all women. And there will still be a struggle to
make sure surgical abortions remain legal and that there are enough providers
trained in and practicing these abortions.
Mifepristone,
which was named RU486 by the French company that developed it in 1980, has been
used in over half a million abortions in Europe for over a decade. Its safety
and effectiveness have been demonstrated.
Approval
for its use in the United States has been delayed for many years because of
right-wing threats of boycotts and protests--and the implied threat of
violence--against the manufacturer, Roussel Ucalf.
To
avoid becoming a target of protests or boycotts in the U.S. that might cut its
sales of other medicines, the French drug maker donated its patent on
mifepristone to the Population Council, a non-profit U.S. group. This group
established a company to distribute the medication in this
country.
How
does RU486
work?
Mifepristone
works by blocking progesterone, the hormone made by a woman's body to maintain a
pregnancy. After a medical examination to determine that she is less than seven
weeks pregnant, the woman would take the pills. Then, after waiting 36 to 48
hours, she must take another medicine called misoprostol. This second drug
brings on contractions of the uterus that expel the fetal tissue and end the
pregnancy.
The
benefits of this procedure are that it can be done very early in pregnancy, it
avoids the invasiveness of a surgical abortion, and it does not require
anesthesia.
An
option, not a
panacea
Those
who support the right to choose should be aware that this type of medical
abortion is not the answer to every woman's needs. The pills must be taken
within seven weeks of the last menstrual period--in other words, before a woman
has even missed her second period.
Menstrual
periods usually occur every month in reproductive-age women, but do not happen
like clockwork for
everyone.
Women
whose periods are normally irregular, including many teenagers, and women who
are breastfeeding or using medications that make their periods stop or become
irregular may not realize they are pregnant soon enough to use RU486. Others who
are unsure whether or not to end the pregnancy may be unable to come to a
decision within that time
frame.
The
procedure also involves multiple medical visits. The pregnancy must first be
confirmed. Accurate dating is obtained by a pelvic exam to check the size of the
uterus. An ultrasound may be required, adding to the expense. Only then is the
RU486 prescribed and
taken.
The
second medication, misoprostol, is administered at a second visit two days
later. A third, follow-up visit is needed two weeks later to make certain that
the pregnancy has been successfully terminated. This is necessary since in about
5 percent of cases RU486 will not work and surgical abortion will be needed
afterwards.
All
this may make medical abortion through RU486 and misoprostol too complicated and
costly for many women, including the millions without insurance.
In
France, where medical abortion has been available for many years and the costs
are insured for everyone, only about one third of the women seeking to end a
pregnancy choose this method.
Women
still need
full
range of
options
While
early termination of an unwanted pregnancy by medical means is a welcome option,
approval for RU486 will obviously not mean the end of surgical abortions.
Advocates of women's reproductive rights must continue to work for the
availability of surgical
abortion.
Already,
anti-choice zealots are working to place the same punitive restrictions on
prescribing abortion pills as exist to curtail surgical services. In some
states, abortion providers must register and report every abortion. Detailed
requirements for the design of facilities where abortions are provided may also
prevent the prescribing of RU486 by physicians who do not already provide
surgical abortions.
Insurance
and malpractice issues may pose further barriers to "mainstreaming" RU486. For
example, several weeks ago, Searle, the manufacturer of misoprostol (the drug
used after RU486 has been taken), mailed letters to health-care providers around
the country warning that it is not approved for use in pregnancy. Obstetricians
have used this medication to induce, or bring on, labor leading to childbirth in
term
pregnancies.
Advances
in technology are welcome, but no pill, no election of a single candidate, no
law alone can safeguard the right to choose. Constant vigilance and struggle on
the part of all who support women's rights must continue.
This article is copyright under a Creative Commons License.
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