Pill alters abortion debate

Christian Century, Jan 26, 2000

AS SUPPORTERS and opponents of legal abortion prepare to square off one more time to mark the January 29, anniversary of the 1973 Supreme Court decision legalizing most abortions, the Food and Drug Administration is quietly preparing to radically alter the political and medical landscape on this volatile and divisive issue.

After years of vicious wrangling and political infighting among nonprofit groups, pharmaceutical companies, abortion rights advocates and abortion opponents, American women will finally gain access to RU-486--"the French abortion pill"--within the coming months. The FDA, which is not commenting on the matter publicly, is in the final stages of discussion with the Population Council over how the drug will be labeled, prescribed and sold, according to officials at the council, a New York-based nonprofit research group which owns the rights to the drug.

Abortion rights advocates already are celebrating the RU-486 revolution to come and privately hoping that the drug's availability will alter the debate over abortion forever. "America is on the brink of an historical moment," said Gloria Feldt, president of Planned Parenthood Federation of America. "Approval and availability of mifepristone [RU-486] will, I think, be comparable to the arrival of the birth control pill 40 years ago."

For antiabortion activists, the bottom line is clear: medical abortion, induced by a drug, is still abortion. Still, they know that mifepristone could significantly redraw the lines in the abortion battle. "Mifepristone will absolutely make our battle harder to fight and harder to win," acknowledged Judith Brown, president of the American Life League. Once mifepristone comes to market, American women will be able for the first time to elect to have a medical rather than a surgical abortion, using mifepristone in combination with another drug, misoprostol.

Doctors who have participated in the clinical trials of mifepristone say the drug's availability will broaden women's choices, enhance privacy, and make abortion safer by eliminating the need for a surgical procedure that requires anesthesia. Experience in countries such as France, where medical abortion is legal, indicates that most women will choose this procedure over surgical abortion, and more women will have their abortions much earlier in their pregnancies because no waiting period is required. In addition, studies by the Henry J Kaiser Family Foundation and others suggest that with the advent of the nonsurgical means, there will be an increase in the number of doctors willing to offer abortion services.

Abortion opponents fear that these developments will blunt the highly emotional and politically explosive nature of the issue, leaving abortion rights advocates with a decisive advantage. "RU-486 could intensify the debate immediately, but the drug will have the long-term effect of muting it," said Kellyanne Fitzpatrick, a Washington-based Republican pollster specializing in gender issues. "It will reinforce the out-of-sight-out-of-mind libertarian attitude toward abortion, and take off the table the ability to show pictures of an unborn child and use anecdotes and be more public about what one group thinks is a private issue and another group thinks is saving a human life."

Medical abortion is neither a quick nor an easy alternative, doctors say. It is a multistep process requiring screening, counseling and follow-up by a doctor in a clinic or medical office. Only after screening does a woman take the pill, followed by another pill 48 to 72 hours later that triggers a process resembling an early miscarriage.

The pill method is considered less traumatic to the body than surgical abortion, in which the uterus is emptied by surgery--an invasive and often painful procedure. Doctors participating in mifepristone clinical trials say women appear to be more comfortable with medical abortion from a psychological perspective, as well. "Mifepristone gives [a woman] a different method of abortion to choose from that allows her to undergo the process in a setting of her choosing with people she wants around, more or less timed for her convenience, in the privacy of her own home," said Paul Blumenthal, director of contraceptive research and programs at Johns Hopkins Bayview Medical Center in Baltimore. "What is most important is that if the patient has a choice, she will feel better about what she decides," he added.

Mifepristone works by blocking the hormone progesterone, which is necessary to sustain a pregnancy. After the drug is taken, the cervix softens, the lining of the uterus breaks down, and bleeding begins. A few days later the drug misoprostol is taken, causing the uterus to contract and expel an embryonic sac roughly the size of a grape, ending the pregnancy.

The side effects of the drug regimen vary. Some women experience no physical discomfort, while others suffer symptoms commonly associated with menstruation and early pregnancy: nausea, vomiting, headaches and heavy cramping. All women will bleed--some lightly, others heavily--for one to two weeks. The risk of hemorrhaging, which requires a blood transfusion, is real but rare.