By Charles L. Rulon
Emeritus, Life & Health Sciences
Long Beach City College
Introduction
In 2000, 12 years after RU-486 (a.k.a. Mifepristone or the abortion pill) became available in France, the U.S Food and Drug Administration finally approved it (with several restrictions) for the early medical termination of pregnancies. By 2008 medical abortions accounted for about one-fourth of all abortions nationwide.
Why the 12 year delay? Because since the late 1970s there has been a “civil war” of sorts in the U.S. over abortion. There have been bombings, shootings, death threats, clinic destruction and physicians murdered. Anti-choice literature continues to claim that it’s no coincidence that RU-486 was produced by the same German company that made the poison gas for the death camps in Nazi Germany.
Yet, comparing the U.S. to Nazi Germany presents a window to the extremist world-view of anti-choice activists. The many pro-choice religious, social and medical groups that endorse a woman’s right to choose would never have done so if they had believed for one second that abortion was equivalent to murdering babies.[1]
The Republicans in Congress and in state legislatures continue to be strongly anti-abortion. In just the first seven months of 2011, some 472 anti-choice state bills had already been introduced. Today, 87% of all counties in the U.S. no longer even do early abortions.
But Mifepristone could potentially diffuse much of America’s (and many developing nations) current abortion “civil war”. It could do this:
a) By moving abortions out of the easily picketed (and bombed) public clinics into the privacy of a doctor’s office and the privacy of one’s own home;
b) By encouraging very early abortions (safer, cheaper, less upsetting, more politically tenable than later ones);
c) By causing a miscarriage that is indistinguishable from a natural one (especially important for women in countries where they risk arrest if they seek help in a hospital after a botched abortion); and
d) By greatly increasing the number of physicians willing to do abortions. Over one-third of doctors interviewed in the U.S. have said they would be willing to dispense Mifepristone in the privacy of their offices.
In addition, 5 out of 6 abortions take place in developing countries where abortion is frequently illegal and/or where poor sterilization and training makes surgical abortions quite dangerous. 70,000 women die every year from botched abortions and millions more need hospital care due to hemorrhaging and life-threatening infections. As a result, having a private medical abortion rather than a public or clandestine surgical one potentially represents a major revolution in women’s reproductive health.
“As word spreads among women worldwide about what a few pills can do, it’s hard to see,”
writes Kristof in the N.Y. Times (8/1/10),
“how politicians can stop this gynecological revolution.”
Basic information
Q. How does Mifepristone work?[2]
A. Mifepristone [Mifeprex™] blocks the action of progesterone. Progesterone is a “pro-gestation” hormone necessary for the uterine lining to support a developing embryo. Without progesterone the uterine lining breaks down and is expelled along with the embryo. When used with the drug, misoprostol a day or two later (which brings about uterine contractions), Mifepristone is over 95% effective if taken within 9 weeks of gestation.
Q. How safe is Mifepristone?
A. All drugs carry some risk. But Mifepristone has proved to be much safer than carrying to term and giving birth. In the 1990′s over 600,000 women in Europe and millions more in China used Mifepristone to terminate an unwanted pregnancy.[3] No deaths were reported. In contrast, dozens of men have already died from using Viagra, a drug with far fewer restrictions. According to the FDA there are no known long term risks associated with using mifepristone and misoprostol.
Therefore, women may pursue another pregnancy whenever they feel the time is right after having a medical abortion.
Q. What are the side effects and cost of a medical abortion?
A. There’s cramping and bleeding similar to an early natural miscarriage. There can also be nausea and diarrhea. It costs about the same in the U.S. as an early surgical abortion (vacuum aspiration). In India, a medical abortion pill kit is sold online for about $5.
Q. How do women who’ve had a medical abortion feel about it?
A. In one study of 1,049 women who had already had an earlier surgical abortion such as vacuum aspiration three-fourths said they preferred the medical abortion.[4] But some women maintain that because of the side effects of a medical abortion they would have preferred a safe, quick abortion via vacuum aspiration . . . . except for the “domestic terrorist” activities of the picketing anti-abortionists at clinics where vacuum aspirations are performed.
Q. Could Mifepristone be used as a “morning-after pill”?
A. Yes! In fact, Mifepristone appears to be better than any of our currently available emergency contraceptive pills. Its success rate is much higher (99% vs. 75%) and there appears to be significantly less nausea, vomiting and headaches.
Q. Are there other uses for Mifepristone?
A. The American Medical Association has endorsed testing Mifepristone as a possible treatment for breast and prostate cancer, glaucoma, certain brain tumors, infertility and endometriosis.
Q. Would the easy availability of Mifepristone result in more abortions?
A. It didn’t in France or Sweden. But there abortion is viewed as a public health issue instead of a sinful/criminal one. The U.S. is a different story. If all it took were a few pills taken in the privacy of one’s home to end an unwanted pregnancy in its very early stages, then who knows? Some have estimated that the abortion rate for early abortions could rise considerably. But pro-choice supporters see such a possible increase as another giant step forward in the ageless quest for women to gain reproductive control over their own bodies and for couples to give birth only to truly wanted children. Besides, if the U.S. and state governments were really interested in significantly lowering the abortion rate, we’d have widespread in-depth sex education and excellent inexpensive contraception, plus emergency contraception readily available for all, including teens. This has been done for decades throughout Western Europe where the teen pregnancy rate varies from one-half to one-tenth of ours.
Q. I’ve read that Mifepristone can cause wide-spread infant deformities. Is this true?
A. No. You’ve been reading dishonest propaganda cranked out by the anti-choice activists. After over 600,000 medical abortions in Europe, Mifepristone has yet to be implicated in any fetal abnormalities.
Q. Didn’t France initially have trouble marketing RU-486?
A. Yes. RU-486 (Mifepristone) was initially developed in France in 1988. But it was only on the market for a month before being pulled from distribution by Roussel–Uclaf, the drug manufacturer, because of intense pressure from mostly American-inspired anti-abortionists. However within one week the French Minister of Health ordered the drug to once again be distributed, stating that RU-486 was “the moral property of women, not just the property of the drug company.” This is in glaring contrast to how the U.S. has acted.
Q. How has our government responded to Mifepristone?
A. Over three decades ago the Republican Party joined forces with the Religious Right and has fought against the right of women to terminate unwanted pregnancies ever since. As a result, under Republican Party leadership Mifepristone studies were banned in the United States up to 1993 when Bill Clinton became President. Clinton immediately issued an executive order lifting the ban and began to exert pressure on Roussel–Uclaf to make this drug available in the United States.
In 1994 Roussel–Uclaf removed itself from this heated controversy by donating the U.S. rights to manufacture RU-486 to the Population Council, a New York-based nonprofit organization that promotes reproductive health.
By 1996, Mifepristone’s safety and effectiveness had been confirmed by the U.S. Food and Drug Administration. Now all that was needed was a manufacturer. And that’s where the whole process bogged down. The anti-abortionists threatened massive boycotts and liability lawsuits against any company seeking to obtain F.D.A. approval to manufacture Mifepristone. They also threatened to target anyone who helped to manufacture, market, sell, or finance its production. As a result, virtually all of the major pharmaceutical companies declined to either produce or distribute Mifepristone.[5]
Also, a number of state legislatures introduced laws outlawing the use of Mifepristone if it ever became available. In 1998 the House of Representatives voted to bar the FDA from using funds for the testing, development, or manufacture of any drug that could be used for an early medical abortion.
Finally, in September 2000, 12 years after it became available in France, the U.S Food and Drug Administration approved Mifepristone for early termination of pregnancy.
Misoprostol
Misoprostol causes uterine contractions. It is used with Mifepristone in medical abortions. Yet, 5 out of 6 abortions take place in developing countries where abortions are frequently illegal. But misoprostol is not illegal. It has long been widely available for treating gastric ulcers and for saving lives of women with postpartum hemorrhages. Also, it is cheap, stable at room temperatures, easy to transport, easy to administer, and does not require refrigeration, even in hot climates. It can be found on Internet sites all over the world.
So what? So researchers have discovered that misoprostol all by itself can be 75-85% effective in terminating an early pregnancy. This makes misoprostol potentially much better and safer than the horrible alternatives available to the tens of millions of women who seek out illegal abortions each year. Active research on the optimal dosing and administration strategy of misoprostol is ongoing throughout Latin America and East Asia.[6] In the roughly 15%-25% of cases where misoprostol administration does not lead to a complete abortion, additional intervention is required.
Some closing thoughts
History has clearly documented that it’s the number of maternal deaths and injuries, not the number of abortions, that are most affected by laws attempting to block elective abortions. In poor countries, the risk of death from an illegal abortion is from 25-100 times greater than it would be from having a legal one.
Also, pregnancies in poorer countries can be very dangerous. Over 600,000 women die yearly from pregnancy-related complications. Since half of these pregnancies were never wanted in the first place, the availability of excellent contraception, plus emergency contraception, plus medical abortions and vacuum aspiration as backups, could prove invaluable. Those who oppose such availability are assisting in the reproductive enslavement of women, the disintegration of millions of families, the spread of poverty, and the increase in the number of illegal abortions.
Yet conservative Christians continue to claim they’re doing God’s will by opposing essentially all abortions. But, since the Bible is silent regarding elective abortions, where is it written that God wants us to force women to stay pregnant against their will—to be unwilling embryo incubators? Where is it written that God wants women to be either celibate or obligatory breeding machines? Furthermore, in spite of biblical interpretations, where is the religious wisdom and social justice today in placing women in a permanently subordinate position to men and essentially in reproductive bondage to the state?
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[1]The Religious Coalition for Reproductive Choice, represents over 40 different denominations and faith groups in this country and can be reached at www.rcrc.org. Also Physicians for Reproductive Choice and Health, which now has thousands of physician members and speaks for over 130,000 physicians in getting RU-486 released. See www.PRCH.org.
[2]www.medicationabortion.com – a multi-language website provides accurate information about medication abortion to health service providers including physicians, nurse practitioners, physician assistants, counselors, and office staff as well as educational information for women considering the option of medication abortion. For additional updates on Mifepristone, check www.earlyoption-pill.com, www.popcouncil.org, www.now.org, www.feminist.org, www.PRCH.org.
[3]As of 2000, Mifepristone was legal in Austria, Belgium, China, Denmark, Finland, France, Germany, Greece, Israel, the Netherlands, Russia, Spain, Sweden, Switzerland and the United Kingdom.
[4]Winikoff, B. et al, 1998, “Acceptability and feasibility of early pregnancy termination by mifepristone-misoprostol: Results of a large multi-center trial in the United States,” Archives of Family Medicine, 7: 360-366.
[5]New York Times Magazine, July 14, 1999.; Feminist Majority Newsletter, Sept. 1999.
[6]Gynuity – http://www.gynuity.org/ – Instructions for Use of Misoprostol for Women’s Health in several languages.