Scientists changed the face of the abortion debate in America last week, moving closer to offering a pill instead of surgery to women seeking to end their pregnancies.
But it’s a complex step that involves making sure women, particularly the poor with no health insurance, actually visit a doctor three times to safely undergo a drug-induced abortion, and that doctors know how to use the controversial drug RU-486.
The Food and Drug Administration still must grapple with these issues as it tries to meet its goal of deciding RU-486’s fate by mid-September.
Whatever the medical issues, the drug is controversial mainly because abortion remains a potent political issue in the United States. On Friday, some 200 people passed through metal detectors to hear the FDA’s outside advisers recommend the agency approve RU-486 after addressing the medical concerns. Nearby, a police line blocked a handful of abortion foes who briefly picketed.
“Obviously there are serious concerns” about how RU-486 will affect women and their doctors, acknowledged FDA Commissioner David Kessler, who wouldn’t say how he was leaning but usually follows his advisers’ recommendations.
The FDA is required to approve any drug found safe and effective if it also is properly manufactured, an inspection yet to be done.
RU-486, known chemically as mifepristone, had a long road here. Used by 200,000 European women, the drug’s French manufacturer was blocked from selling it here by antiabortion protests. A 1994 Clinton administration deal gave the nonprofit Population Council U.S. rights to RU-486 so it could seek FDA approval.
A few U.S. doctors already use a cancer drug to induce abortions, but RU-486 could become the first FDA-approved abortion pill.
Opponents fear that stamp of approval will make abortion more common. Surveys show many doctors who shun the outpatient surgery facilities required for today’s abortions, which are targets for picketing and even violence, say they might offer RU-486 in their private offices.
“As the number of abortionists increases, the number of abortions also rises,” contended Wanda Franz of National Right to Life. “How can President Clinton claim to want abortion to be rare when he is directly to blame for pushing forward this drug combination, which is deadly to unborn children and dangerous to their mothers.”
But one top Republican suggested that anti-abortion activists not focus their energies on RU-486.
“I’m not sure at a practical level how people are going to keep this out of the country,” House Speaker Newt Gingrich told reporters Saturday. He counseled the anti-abortion movement to instead concentrate on over-turning Clinton’s veto of a bill that would ban certain late-term abortions.
“My advice to everyone who is right-to-life is that the focus ought to be on partial-birth abortion,” Gingrich said in Marietta, Ga.
RU-486 defenders say abortions didn’t increase when the drug was approved in France in 1988.
RU-486 works 95.5 percent of the time when taken within the first seven weeks of pregnancy. Advances in Health Technology, a Washington firm that will distribute RU-486, has hired a manufacturer to produce enough of the drug for 650,000 women, the proportion of the nation’s 1.3 million annual abortions already performed in the first seven weeks of pregnancy, said AHT President Dr. Susan Allen. She won’t name the manufacturer yet for fear of anti-abortion opposition.
Two days after taking RU-486 to end the pregnancy, women must take a second drug to cause strong uterine contractions that expel the fetus. While somewhat painful, serious complications are rare: Four of the 2,100 American women who have tested RU-486 needed blood transfusions.
But then women need yet another doctor’s exam, to catch the abortions that failed so those women can quickly have the abortion finished surgically.
How, the FDA’s advisers repeatedly asked, can RU-486 providers ensure that women return? Poor women especially may skip that vital exam because they can’t afford it, can’t miss work or can’t find child care, said Dr. Cassandra Henderson of New York’s Albert Einstein College of Medicine. “I am very concerned.”
“We can never force anybody to have a surgical abortion,” acknowledged Ann Robbins of the Population Council.
But AHT’s plan is to make women sign a form agreeing to return before giving them RU-486. The third visit and any necessary surgery will be included in the several hundred dollars the abortion will cost, Robbins said.