C Rulon: Medical Abortions (A potential revolution in women’s reproductive health)

By | September 12, 2011

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.

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