The Little (Abortion) Pill that Could

This article is reprinted from the American Prospect.

In the mid-1990s, the abortion wars were at a fever pitch over the impending approval of RU-486. Time magazine called it "The Pill that Changes Everything," The New York Times Magazine dubbed it a "little white bombshell," and anti-abortion leaders said over and over that this drug was dangerous because it would make having an abortion "as trivial as taking aspirin." Pro-choicers, for their part, were invigorated by the possibility of giving women another abortion option, one they hoped would let them largely bypass abortion clinics and the attendant protesters at the gates.

But for all the controversy about mifepristone, the active drug in RU-486, there wasn't much attention paid to the fact that many doctors were already providing abortions in pill form using a drug called methotrexate, which had been FDA-approved for years as a treatment for cancer, arthritis, and Crohn's disease. Because methotrexate was useful in many more ways than abortion, it was more loosely regulated and readily available. And because the methotrexate was approved for a variety of illnesses, it was politically impossible for anti-abortion groups to push the FDA to revoke its approval.

This article is available on The American Prospect website. © 2007 by The American Prospect, Inc.

"Nobody's trying to get that drug off the market," says Beth Jordan, medical director for the Association of Reproductive Health Professionals. "We want to see mifepristone enjoy that same place on the market. If the science is there."

That's why, even before mifepristone was FDA-approved as an abortion pill, pro-choice groups began supporting research into whether the drug can be used to treat depression, cancer, and reproductive system disorders. So far the results are encouraging. In November, one researcher attracted considerable press when she released findings that she had successfully used mifepristone to treat breast cancer in mice. The announcement gave pro-choicers hope that they were a step closer to pushing for FDA approval for a use other than abortion.

Although only about 10 percent of the 1.29 million abortions performed in the United States every year use the medication method, the battle over the drug has been particularly bitter. While a woman must obtain mifepristone at a clinic, the actual abortion happens in the privacy of her home. Currently, medication abortion is common in many countries where the procedure is illegal, because it's decidedly less risky than using a wire hanger. In fact, in the absence of a doctor, it's the safest and easiest way for a woman to perform a do-it-yourself abortion. Which is another reason why pro-choice groups would like it approved for alternate uses and see its availability increase. If abortion were ever outlawed in the United States, mifepristone would become perhaps the most important -- and the most common -- abortion option.

It took pro-choice activists 12 years to get the abortion pill -- of which mifepristone is one of two components -- approved by the FDA. Though it had been used in some European countries since the early 1980s, American abortion politics caused the drug's European makers to shy away from patenting and marketing the drug here. After a series of hang-ups, clinical trials were completed in the late 1990s and the FDA agreed to consider approval. Despite objections from anti-abortion groups and conservative congressmen, mifepristone was FDA-approved for abortions in September 2000. (More recently, the drug came under renewed scrutiny when at least four women died of a rare bacterial infection after taking the pill. The anti-abortion movement seized on the deaths to push for a ban on mifepristone. But after two more people died of the same rare bacteria, many experts questioned mifepristone's role in the deaths.)