------------------------- Via Workers World News Service Reprinted from the Oct. 12, 2000 issue of Workers World newspaper ------------------------- THE "ABORTION PILL": A VICTORY BUT NOT CURE-ALL By Ellen Catalinotto Certified Nurse-Midwife New York On Sept. 28 the Food and Drug Administration approved the marketing of RU486, the "abortion pill" sought for many years by advocates of women's reproductive rights. Since these abortion-inducing pills could be dispensed from any doctors' offices, this could help end the isolation of abortion clinics, which have become targets of right-wing attacks by anti-abortion forces. Those who are pro-choice welcome this drug's legalization, which expands the options and enhances the privacy of women seeking to end an unwanted pregnancy. But they should be aware that it will be no magic cure-all for those wanting to guarantee the right of women to reproductive freedom. There are many battles ahead to make RU486 legally available and financially accessible to those who want it. But it may not be the appropriate way to terminate unwanted pregnancy in all women. And there will still be a struggle to make sure surgical abortions remain legal and that there are enough providers trained in and practicing these abortions. Mifepristone, which was named RU486 by the French company that developed it in 1980, has been used in over half a million abortions in Europe for over a decade. Its safety and effectiveness have been demonstrated. Approval for its use in the United States has been delayed for many years because of right-wing threats of boycotts and protests--and the implied threat of violence--against the manufacturer, Roussel Ucalf. To avoid becoming a target of protests or boycotts in the U.S. that might cut its sales of other medicines, the French drug maker donated its patent on mifepristone to the Population Council, a non-profit U.S. group. This group established a company to distribute the medication in this country. HOW DOES RU486 WORK? Mifepristone works by blocking progesterone, the hormone made by a woman's body to maintain a pregnancy. After a medical examination to determine that she is less than seven weeks pregnant, the woman would take the pills. Then, after waiting 36 to 48 hours, she must take another medicine called misoprostol. This second drug brings on contractions of the uterus that expel the fetal tissue and end the pregnancy. The benefits of this procedure are that it can be done very early in pregnancy, it avoids the invasiveness of a surgical abortion, and it does not require anesthesia. AN OPTION, NOT A PANACEA Those who support the right to choose should be aware that this type of medical abortion is not the answer to every woman's needs. The pills must be taken within seven weeks of the last menstrual period--in other words, before a woman has even missed her second period. Menstrual periods usually occur every month in reproductive- age women, but do not happen like clockwork for everyone. Women whose periods are normally irregular, including many teenagers, and women who are breastfeeding or using medications that make their periods stop or become irregular may not realize they are pregnant soon enough to use RU486. Others who are unsure whether or not to end the pregnancy may be unable to come to a decision within that time frame. The procedure also involves multiple medical visits. The pregnancy must first be confirmed. Accurate dating is obtained by a pelvic exam to check the size of the uterus. An ultrasound may be required, adding to the expense. Only then is the RU486 prescribed and taken. The second medication, misoprostol, is administered at a second visit two days later. A third, follow-up visit is needed two weeks later to make certain that the pregnancy has been successfully terminated. This is necessary since in about 5 percent of cases RU486 will not work and surgical abortion will be needed afterwards. All this may make medical abortion through RU486 and misoprostol too complicated and costly for many women, including the millions without insurance. In France, where medical abortion has been available for many years and the costs are insured for everyone, only about one third of the women seeking to end a pregnancy choose this method. WOMEN STILL NEED FULL RANGE OF OPTIONS While early termination of an unwanted pregnancy by medical means is a welcome option, approval for RU486 will obviously not mean the end of surgical abortions. Advocates of women's reproductive rights must continue to work for the availability of surgical abortion. Already, anti-choice zealots are working to place the same punitive restrictions on prescribing abortion pills as exist to curtail surgical services. In some states, abortion providers must register and report every abortion. Detailed requirements for the design of facilities where abortions are provided may also prevent the prescribing of RU486 by physicians who do not already provide surgical abortions. Insurance and malpractice issues may pose further barriers to "mainstreaming" RU486. For example, several weeks ago, Searle, the manufacturer of misoprostol (the drug used after RU486 has been taken), mailed letters to health-care providers around the country warning that it is not approved for use in pregnancy. Obstetricians have used this medication to induce, or bring on, labor leading to childbirth in term pregnancies. Advances in technology are welcome, but no pill, no election of a single candidate, no law alone can safeguard the right to choose. Constant vigilance and struggle on the part of all who support women's rights must continue. - END - (Copyleft Workers World Service: Everyone is permitted to copy and distribute verbatim copies of this document, but changing it is not allowed. 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