The New Battle Lines of Abortion
The battle lines in the Thirty Year War over abortion are girding for what conventional wisdom says will be a huge change in the paradigm. The French abortion pill RU-486 is on the verge of approval by the Food and Drug Administration.
Within the first seven weeks of a pregnancy, American women -- including 13,000 to 16,000 in Indiana each year -- will soon have access to RU-486, a combination of Mifepristone and Misoprostol. Mifepristone blocks progesterone, the key hormone that establishes and maintains a pregnancy. A spontaneous miscarriage results when Mifepristone is followed by Misoprostol, which prompts the uterine lining with the embedded embryo to slip away.
Pope John Paul II has called RU-486 the "pill of Cain." But both sides of the abortion struggle come together on one point: RU-486 will make the procedure more accessible.
"Women will likely gain access to early abortion from their neighborhood physicians in privacy -- the way all medical decisions should be carried out," says Sandra Anderson, a medical services employee for Planned Parenthood. "No longer will religious political extremists be able to use violence and intimidation to block women's access to abortion clinics."
Right to Life activist Mike Fichter agrees on one limited point: "It will broaden access to abortion by making it available other than at a clinic or hospital. That will increase the abortion rate in the United States," Fichter predicts. "It also says something about our culture. By ingesting a pill, ending a life becomes morally acceptable."
The FDA approval of RU-486 has serious implications for the American presidential election in November. President Clinton stated last January, "There is absolutely no question in my mind that whether Roe vs. Wade is preserved or scrapped depends on what happens in the presidential election and to pretend otherwise is naive."
The supreme irony in this situation is that few people realize that medicinal abortions are already here.
It's Already Here
Sandra Anderson's voice cannot hide an inner pride when she notes that she "predates" the legalization of abortion. One of her first jobs back in the 1960s was as operating room nurse. "I saw one of my classmates come in after a coat hanger abortion," she says. "I'll never forget it. If it happened in towns of 500 people, you know it's happening in many other places." But when the conversation turns to RU-486, Anderson states, "You know we've been offering medical abortion for years. It's just going to be another drug."
With almost none of the fanfare surrounding RU-486, the FDA in 1998 approved five pilot projects for another medicinal abortion procedure: the antimetabolite Methotrexate, taken in tandem with Misoprostol, the drug manufactured by G.D. Searle. Methotrexate stops embryonic growth by blocking cell divisions, while Misoprostol induces the miscarriage. Methotrexate has almost identical attributes as RU-486. It is used during the first seven weeks of a pregnancy.
While Mifepristone is said to be 95 to 97 percent effective, Methotrexate is 90 to 95 percent effective. If either drug fails, the surgical abortion -- vacuum aspiration -- is available to terminate the fetus.A pregnant woman can go to a Planned Parenthood clinic and receive an injection of Methotrexate. She then goes home and vaginally inserts the Misoprostol pills five to seven days later. She returns to the clinic for a follow-up visit.
With Mifepristone, the woman receives the drug orally. Two days later she returns to the clinic where she takes Misoprostol orally and then stays for observation for up to four hours. A third follow-up visit may be needed.
Once the pilot program ended, the FDA approved Methotrexate for pregnancy termination in 1999 -- with almost no controversy. "We're quite happy with Methotrexate," Anderson says. "But very few women are opting for it. We've had 3,343 women who have come to one of our facilities, and only 28 opted for the medical abortion. You can see that it is not as popular as surgical abortion."
The Pill of Cain
So why has Mifepristone become a lightning rod in the abortion debate while Methotrexate has silently slipped into the picture?
Answers lie partly in industrial European history, partly in the medical research and decisions by the French government, and partly because of a notion that American women were being denied a treatment available to their sisters across the Atlantic.
Mifepristone was developed by the French company Groupe Roussel Uclaf and announced in 1982. It created an immediate sensation. For the first time women could terminate a pregnancy prior to the sixth week required for a surgical abortion. This would be prior to the embryo taking on human features, an element that often adds to a woman's emotional burden.Pregnancies could be ended in local clinics, hospitals or doctors offices.
Predictably, pro-life groups across the globe reacted negatively, fearing that RU-486 was just one more facet of the so-called "fast food society" that would make abortion easy, even routine. They threatened worldwide boycotts.
There was an added burden to bear with RU-486. Roussel Uclaf is a majority owner in Hoechst AG. Hoechst is the German firm with roots in IG Farben, the company that manufactured Zyklon-B, the so-called "human pesticide" the Nazis used in their Holocaust gas chambers during World War II. What's more, then-Hoechst CEO Wolfgang Hilger has been described as a devout Catholic.
Bowing to these pressures, Roussel Uclaf announced in 1988 that it would not manufacture the drug. After several days of outrage from women's and reproductive rights advocacy groups, the French government stepped in and ordered Roussel to manufacture and distribute RU-486 or sell the patent. French Health Minister Claude Evin claimed that the drug was the "moral property of women, not just the drug company."
Methotrexate has less controversial industrial origins. Manufactured by Lederle, it was originally approved by the FDA as a treatment for arthritis and some forms of cancer. In 1993, the University of California at San Francisco announced it had conducted a USDA-approved pilot study."It's been around a long time," Sandra Anderson says, "but nobody had done the research."
Critics say that MTX is extremely toxic and unpredictable. The RU-486 Report by the Life Issues Institute quotes Dr. Hakim Elahi, medical director of Planned Parenthood in New York City, as saying, "I don't believe many physicians in this country would use it. It's a highly toxic drug."
What pro-choice advocates are hoping is that once the FDA approves Mifepristone, it will open up the floodgates of access. A number of national studies suggest that is exactly what will happen.
A 1998 New York Times/CBS News poll revealed that 61 percent of Americans favor first trimester abortions (15 percent for second trimester and only 7 percent for third or partial birth abortions).
A 1998 Henry J. Kaiser Family Foundation survey of family practitioners revealed that 45 percent of doctors said they were "very" or "somewhat likely" to prescribe Mifepristone. The same study showed that 54 percent of nurse-practitioners would be inclined to prescribe it. The survey revealed that only 3 percent of doctors and 2 percent of nurse practitioners would or had performed surgical abortions.
A 1996 study by the Society for Adolescent Medicine revealed 42 percent of doctors would prescribe medicinal abortions, compared to 2 percent who currently offer surgical procedures.
But for Right to Lifers, the 1973 Roe vs. Wade decision that allows for legal abortions is tantamount to the 1857 Dred Scott decision that denied African-Americans human status. "This is a long-term battle, just as abolition was," Fichter observes. "It will be in the American forefront for decades."
Anderson responds: "I acknowledge their belief and I hope those people don't have an abortion. It's a choice. If you don't want one, don't have one. If you do, you should be able to choose from several different options. For many women this is a long, agonizing decision. We have people who change their minds when they get to the table. The positive thing here is these women won't have to go through the hassles to attain the right they have. You should be able to go into any physician's office in any town and get a medicinal abortion."
The author of this first-person account of an abortion wishes to remain anonymous.
The summer after my sophomore year of college I got pregnant.I had recently become engaged to my high school sweetheart and was in the process of transferring schools when I found out that my fiance had slept with someone else. I promptly canceled the wedding and enrolled in the university located in my hometown.During that summer I dated a guy named Shane. He lived a somewhat bohemian lifestyle that I loved. I reveled in the freedom, but most of all I craved the change from my own, buttoned-down existence, and the fact that he had a motorcycle didn't hurt.Well, Shane let me down, too. He had an affair while visiting some friends out of town. About that time, my ex and I reconciled and re-set the wedding date.Shortly after, I found out I was pregnant.I had always been pro-choice, but I thought if I ever got pregnant I would go through with it. I was afraid, though, that if I told my soon-to-be husband that I was pregnant with someone else's child, he would leave me -- not only out of anger, but out of doubt over my loyalties. Our relationship road had always been rocky, but down deep I knew I loved him, and was meant to be with him. I saw this pregnancy as my transgression, and I decided to mend it.The town I lived in didn't provide abortion services, so in the wee morning hours Shane drove me to a neighboring city several hours away for my 8 a.m. appointment.I was terrified. I had no idea what to expect; but the overriding feelings I had weren't of the baby, but of the man I loved. I felt guilty for getting pregnant, I felt guilty over having to do this without his knowledge.The procedure itself was quick, but it felt like centuries. After changing into a hospital gown, I was taken into a room. The thing I remember most was the noise of the sucking machine and the face of the kind nurse who stood next to me and held my hand during the five minute procedure. It wasn't very painful; worse than a pap smear but not unbearable. After it was over they took me into a recovery room with big padded chairs and other women who had just been through the same thing. They put my panties back on me and gave me a maxi pad to absorb the light flow of blood. I had to eat some cookies and drink some Sprite, as you can't eat anything the day of the abortion, and they don't want you passing out from low blood sugar.I sat and cried in that room, not because of the thought of having lost my baby, but because I was scared and traumatized by the entire episode -- from the car ride at dawn, to being denied the support of Shane during and after the procedure, to not really knowing how this was going to effect my body, to the overriding feelings of guilt for what I had done to my fiance. These feelings stayed with me, from collapsing in the bathroom while trying to get dressed to leave, to the entire car ride home, to the sleep that consumed me the rest of the day.I think daily about the fact that I've had an abortion. But I know that what I did at the time, when I was only 20 years old, was the right thing for me. My husband and I eventually got divorced, but I finished college and went to England. I have the job I always dreamed of and am a valued and productive member of society, instead of a single mother working at a low-paying job in my hometown. Having an abortion is a traumatic experience, but so is giving birth before you are ready. I'm glad I had the opportunity to make that choice.