RU Pissed Off Yet?

After 10 Long Years, American Women May Finally Get the Abortion Pill—With Restrictions that Could Obliterate All It Has to Offer

The year is 1990. George Bush (no "W") is president. MC Hammer is number one on the pop charts. Ghost is in the theaters. And a woman in the early stages of pregnancy can have a safe, legal, medical abortion with RU-486—in France, anyway.

Flash . . . forward? Here in the 21st-century United States, RU-486 is still unavailable, caught in a gnarly tangle of politics. With several expected approval dates already come and gone, the Food and Drug Administration recently set yet another deadline by which it promises to rule on the drug: September 30. But even if the agency keeps to its schedule—by no means a sure bet—RU-486 is already long overdue. In international use and American clinical trials, the little yellow tablet has proved to be just as safe as many drugs already approved by the FDA. Even so, the agency recently let on that if it does finally approve the abortion pill, it may do so with serious restrictions that could destroy most advantages the drug has to offer. With the FDA deadline perilously close to election day, and a chip off the first anti-choice Bush pushing toward the White House, there is no better time to take a good, hard look at the pill that could irrevocably transform abortion in the U.S. Will RU-486 finally make it into the average American doctor's office so that a woman can easily end an unwanted pregnancy in its first weeks? Or will government-mandated restrictions and strategically placed legal hurdles ultimately render the first big innovation in abortion meaningless?

many women report feeling "less guilty" about medical abortion. some even say it feels more like bringing on a late period or taking the morning-after pill than having an abortion.

Western medicine's first approved nonsurgical abortion method, RU-486—which is also known as mifepristone—is in many ways a successor to the teas and tinctures women have used for centuries. (For a look at an underground abortion drug, see "The Star Pill.") When taken with misoprostol, an ulcer medication that's already approved and available in the United States, RU-486 blocks the hormone that gets the body ready for pregnancy; within hours after a woman takes the two pills (one 24 hours after the other), the lining of the uterus breaks down and the pregnancy ends. But, because it works from the very earliest stages into the seventh week, many see RU-486 as a method that can prevent pregnancy from beginning—a distinction that could prove huge. For women who have taken it, RU-486 often sidesteps the stigma of having an abortion; a pill, many of them say, feels more natural and less invasive. Most doctors, too, seem to be more willing to prescribe a medication than to perform a surgery, however minor.

That's certainly been the case in France, where some 25 percent of abortions are now done with RU-486, which is widely available in French doctors' offices. France, it should be noted, is not some sort of women's rights mecca, where toilet seats are welded down and tampons are free. The country has its own history of strife over reproductive rights, its own bands of zealots bent on forbidding abortion at all cost.

In fact, a few such abortion opponents were at the helm of Roussel Uclaf, the very company that developed RU-486 back in 1980. (1980!) In late 1989, two years after the safety and efficacy of the drug were established in French clinical trials, these executives—as well as the Roussel's head of security, who was recruited into the effort because of his strong antiabortion beliefs—tried to overpower their pro-choice colleagues within the company and force Roussel to abandon the drug. The antiabortion faction of the company had already written a press release announcing the decision, when an 11th-hour countercampaign saved the first major abortion breakthrough from oblivion. A petition with more than 2000 signatures and a flurry of press coverage quashed the anti-RU-486 rebellion. Despite political opposition, the French minister of health declared RU-486 "the moral property of women." By April of 1990, the drug was on the French market.

imagine. instead of facing a phalanx of picketers and being called a murderer, a woman could simply go to her regular doctor's office and, depending on the specific regimen the FDA approves, even abort at home.

Since the French started stocking RU-486 in their drugstores, a steady stream of countries have followed suit. RU-486 (which pro-choicers sometimes call the "early option pill" and the pope likes to refer to as "the pill of Cain") is now approved in Great Britain, Sweden, Switzerland, Austria, Belgium, Denmark, Spain, Finland, Greece, Germany, the Netherlands, and Israel. Even China has manufactured its own version of RU-486. As the years have ticked by, more than 500,000 women have had abortions with the drug in Europe alone. (For a history of RU-486, see "Time Marches On.")

Exactly why is the moral property of women still not in our doctors' offices? It's a story of blatant political maneuvering, some well-intentioned bungling, and more politics. American antiabortion activists first put out the unwelcome mat even before RU-486 was approved in France, pushing Reagan and then Bush to prevent the FDA from reviewing the drug. Bush issued an "import ban" in 1989. Then, in 1994, abortion opponents organized a boycott of American subsidiaries of Roussel Uclaf, targeting big moneymaking products, such as the allergy drug Allegra. Sufficiently spooked, the company bolted the American abortion controversy, and—under pressure from President Clinton—donated its U.S. patent to a nonprofit organization, the Population Council.

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