The Myths and the Realities

RU486: One Year After U.S. Approval

By Randall K. O'Bannon, Ph.D., Director of Education & Research

Back in September 2000, when the Food and Drug Administration (FDA) approved the abortion pill RU486, supporters were ecstatic. It was nothing less than a "victory for women and for individual freedom" that could "change the debate about abortion" (Planned Parenthood statement, 9/28/00).

One Seattle family planning clinician actually went so far as to say, "The approval of mifepristone [RU486] hopefully leads the way to a more enlightened and compassionate era in our society" (American Health Consultants "Fax Alert," 9/29/00).

One year later, it seems a good time to ask a few questions. Has RU486 been a "victory for women"? Has it made abortion any safer (for women)? Has it made women's abortion experiences any easier? Has it changed the "debate about abortion"? Has it led the way to a more enlightened, more compassionate, more free society?

If you read a spate of stories that appeared in early October, the only conclusion you could reach is yes! But in fact, as we shall see, the answer to all these questions is "no."

Women aren't better off and the country isn't better off for the FDA's decision. The only good news is that relatively few women and doctors have fallen prey to the false promises of safe and simple non-surgical abortions.

Is Abortion Safer?

One of the major selling points for RU486's supporters is that a woman having a chemical abortion could avoid the risks associated with surgical abortion. When it was setting up the initial American trials of RU486 in 1994, the Population Council, the U.S. sponsor of the pill, highlighted the fact that with a "successful" chemically induced abortion that featured RU486 and a prostaglandin (PG) to trigger contractions, "There are no risks of anesthesia or uterine perforation or cervical canal injury, rare complications of surgical termination of pregnancy."

But the truth is that the chemical method isn't safer. Women are simply trading one set of risks for another.

Provided the woman isn't part of the 8%-23% for whom the chemical method fails (meaning a surgical abortion is required), the woman using the RU486/PG combination simply faces a whole new set of risks and dangers, ranging from hemorrhage to heart failure.

Women bleed nearly four times more from a RU486/PG abortion as they would from a standard first trimester suction curettage abortion. At least one out of every fifty women who took it in trials bled so badly they required some form of surgical intervention. One woman in a hundred participating in the U.S. trials ended up in the hospital.

Distributors of the drug admit that they've seen more pelvic infections in women who taken RU486 than they did during the trials (Los Angeles Times, 10/1/01). Reports of a woman who died in Canadian trials of the drug have also recently come to light. (See accompanying story, p. 21.) The RU486/PG method may be different from the surgical method, but it isn't necessarily any safer.

Are Women's Abortion Experiences Any Better?

Early on, Mademoiselle magazine (November 1988) dubbed RU486 the "miracle pill." Ms. magazine (April 1987) rhapsodized about RU486 as if it were magic: "Imagine being pregnant, swallowing a pill, and presto! not being pregnant any longer."

The image of RU486 as some sort of magic pill that makes the baby "go away" has caused many desperate women to inquire about the abortifacient. However, many balk when they learn the reality is quite different (San Francisco Chronicle, 9/24/01; Virginian-Pilot, 9/24/01), something more akin to a nightmare than a fairy tale. As bad as surgical abortions are, many see chemical abortions as something worse.

Instead of the impersonal, mechanical, abrupt, invasive trauma of the standard 15-minute surgical procedure, the woman having an RU486/PG abortion faces a long, bloody, arduous, physically and psychologically taxing abortion that takes days or even weeks to complete. This drawn-out affair requires a minimum of three office visits over a two-week period, and necessitates her keeping her doctor's number or the address of the nearest emergency room next to her phone. And it still may not "work."

This is hardly what any rational person would call an improvement.

Has the "Debate" over Abortion Changed?

Promoters of the pill have repeatedly forecast that RU486 would "change the debate" over abortion. But what does RU486 really change? The issue has never been when, where, or how an abortion was performed, but rather the fact that abortion involves the destruction of innocent human life. And none of that changes with RU486.

All that's really happened here is that the abortion lobby has invested an enormous amount of time, energy, money, and ink in a failed and futile makeover of the abortion industry. They've spent this past year in particular trying to change their image and the image of abortion. But at least one study - - and reports from all over the country - - are telling us that women aren't buying it, doctors aren't buying it, and the American public isn't buying it.

Lots of Hype, Spin from the Pill's Supporters

The headline of a National Abortion Federation press release (9/24/01) says, "One year after FDA approval of mifepristone, health care providers are offering and patients are choosing this safe early abortion option."

"Since mifepristone became available last year, we have been flooded with calls from women seeking more information about this option," said Vicki Saporta, executive director of the National Abortion Federation (NAF), in the release. Saporta said about half of its members - - 200 "health care facilities" - - currently offer the drug, with more adding it. Since January 2000, NAF claims to have "educated" more than 3,200 health care professionals in some 25 seminars around the country to administer the drug.

In addition to advertising in medical journals, this summer NAF launched a $2 million advertising campaign that ran in over a dozen national magazines projected to reach 70% of all women between the ages of 18 and 49. "Our public education campaign has resulted in a steady increase in calls to our toll-free abortion hotline," said Saporta. "Currently, close to 40% of the calls to our hotline are from women seeking more information about medical abortion" [what they call chemical abortions such as those using RU486]. The response of women and "health care professionals" to the availability of RU486 has been, in Saporta's words, "very positive."

In her own statement, Planned Parenthood president Gloria Feldt said the reports Planned Parenthood has received "have been very positive and reinforce our commitment to bring this new option to more women." Planned Parenthood says approximately two-thirds of its clinics that do abortions currently offer this method.

From the comments above, one might be led to believe that RU486 has taken the country by storm and become the preferred abortion method of American women and doctors. The truth is far different.

Kaiser Survey: Little Demand, Few Doctors Offering Drug

Unquestionably, expectations for the drug were very high. A study (6/8/00) done by the Henry J. Kaiser Family Foundation just prior to the drug's approval suggested that 44% of gynecologists and 31% of family practitioners were at least "somewhat likely" to offer RU486 once FDA approval came. If true, this would be an enormous change.

But a national survey conducted by Kaiser over the summer found that only about 6% of gynecologists and just 1% of family practitioners were offering the drug. Even among regular abortionists, only 12% say they have used the drug.

Forty percent of gynecologists and 37% of general practitioners said they do not offer RU486 because they "personally oppose" it. The top reason (cited by 62%) given by the rest of those for their decision not to offer RU486 was a "lack of patient demand."

Nearly half of that remaining group cited a "lack of interest in performing abortions" (49%), the fact that their "office space is not set up to offer medical [chemical] abortions" (48%), and a belief that there was "too much controversy surrounding abortion" (47%).

Doctors: Problems with Costs, Commitment, Complications

Doctors and clinic personnel speaking to local newspapers gave additional reasons. "We're not hesitating to provide RU-486 for any medical reason," said Suzette Caton, administrator a clinic in the tidewater region of Virginia. "Our hesitancy is cost" (Virginian-Pilot, 9/24/01).

A local gynecologist simply told the medical reporter for the Denver Post that "[t]hey priced it too high" (9/24/01). The standard dose of RU486 runs $270, nearly as much or more than clinics charge for standard first-trimester surgical abortions.

When charges are tacked on for three office visits, an ultrasound, the extra time it takes to explain the procedure and its risks, and any extra personnel needed to handle these tasks, the cost gets too high or the profit margin too low to make it worth the effort.

"The medication cost alone is so high, and when you add the physician fee and the cost of the ultrasound, the cost was prohibitive," one said New Jersey abortionist who originally considered offering it. "Once we presented it to our patients, they all said no" (Bergen Record, 9/25/01).

Some places that are offering it are charging double what they charge for surgical abortions (Bergen Record, 9/25/01). Other clinics that are offering the abortion pill are ignoring the FDA-approved regimen and reducing the dose (from three pills to one) in order to stay competitive and profitable (USA Today, 10/1/01).

Kathryn Kolbert of the University of Pennsylvania's Annenberg Public Policy Center mentions higher malpractice insurance premiums as another one of the possible factors keeping doctors away (USA Today, 10/1/01).

An official spokeswoman at the Northside Women's Clinic in Atlanta, Georgia, justified her center's decision not to offer the drug by pointing out to a Jacksonville Times-Union reporter (9/22/01) that "[i]t's a little hard to manage." Physicians there indicate they don't want to deal with all the extra office visits the method requires. The FDA regimen calls for a minimum of three visits over a two-week period.

"We are not using it and don't intend to," a Sacramento obstetrician-gynecologist told the Sacramento Bee (10/3/01). "The main reason is it does require very close follow-up with the ability to do ultrasound and a [surgical abortion] if necessary on top of that. We don't have in-office ultrasound."

The side effects and complications that often accompany RU486/PG abortions also frighten many doctors away. Robert Livingston, an abortionist from Boca Raton, Florida, told USA Today, "You get a reputation if you have a couple of patients who show up bleeding in the emergency room." The demand isn't there anyway, Livingston says, because he only gets about one call every two weeks or so (USA Today, 10/1/01).

Richard Hausknecht, medical director for Danco, the firm handling U.S. distribution of the drug, said, "When doctors begin to realize they may be losing patients because they are unwilling to provide a service that is legal, simple, and effective, they are going to say, 'Wait a minute, maybe I better offer it'" (Sacramento Bee, 10/3/01).

The truth is, doctors are likely to see a real financial disincentive to adding the drug to their practices. Maternity patients who find their doctor is doing chemical abortions "on the side" may decide to go elsewhere for their medical care. Even among those with ambiguous feelings about abortion, the idea of trusting one's life and the life of one's child to a person who treats life so casually is unnerving.1

Women: Less Interested the More they Learn

The deluge of phone calls by women seeking info on RU486 reported by representatives of the abortion industry are also misleading. Women may call, but they don't buy.

Women aren't sure what RU486 is or does, and the abortion industry and its allies in the media haven't always done what they could to clarify things. While 61% of women aged 18-44 surveyed by Kaiser said they had heard about mifepristone or RU486, only 14% were able to distinguish it from "morning after" pills or from birth control methods used before sexual relations.

Suzette Caton, the administrator of the Hillcrest Clinic in Virginia, said many women are disappointed when they find out RU486 is a lot more complicated than swallowing an aspirin. "It's not like pop a pill and poof you're not pregnant," she told the Virginian-Pilot (9/24/01). Jana Cunningham, spokeswoman for Planned Parenthood Golden Gate, echoes Caton, saying, "Many of our clients thought it was a magic pill: just take it, and you are no longer pregnant. That's not the case" (San Francisco Chronicle, 9/24/01).

One of the abortion clinics which held a news conference to herald RU486's arrival in California now confirms there is little demand for the drug. "We saw a huge interest when it first became approved and it was in the news," the executive director of Women's Health Specialists clinic told the Sacramento Bee (10/3/01). "Then, after a few months, it trickled down to less than 5% of the clients we see."

Even those who sign up for the chemical method often change their minds. Ellen Brilliant, spokesperson for Planned Parenthood's Rocky Mountain affiliate, said, "Early on, among women who made appointments for mifepristone, about half would choose to have a surgical abortion" (Denver Post, 9/24/01). Brilliant speculated that some women were turned off by the additional cost while others didn't like the idea of three visits to the doctor's office.

The unpredictability of the process also bothers many women. With RU486, doctors have no way of determining when the abortion will occur, how rough and bloody it will be, or whether it will even take place at all. "Sometimes," said Hillcrest's Caton, "if not much is happening after a week, patients will ask, 'Can't you just do the surgery and get it over with?'" (Virginian-Pilot, 9/24/01).

Will Falsehood Fly in the Future?

Kaiser's survey finds another 16% of gynecologists and 7% of general practitioners reporting it "likely" that they will begin offering RU486 in the coming year, but it is unclear why these promises should hold any more water than those made by the same group a year ago.

"I don't think RU-486 has had any impact," Dr. David Peters, medical director of Planned Parenthood's Southeastern Virginia affiliate, told the Virginian-Pilot (9/24/01). "The hope was that this would make abortions easier to provide and private, but that's not been the case, unfortunately."

Fortunately, the abortion pill hasn't caught on like it could have. The bloody, painful, taxing reality of RU486/PG abortions has been too big of an elephant to hide in the living room of the abortion industry's makeover campaign. Despite the new packaging, the product is still the same old death and danger that they've been peddling since 1973.

NOTE:

1 An interesting case study mentioning this consequence is Carol Joffe, "Medical Abortion and the Potential for New Abortion Providers: A Cautionary Tale," Journal of the American Medical Women's Association,Vol. 55, No. 3 (Supplement 2000), pp. 151-154, at 153 and 154.