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Nevertheless, the FDA denies its treatment of mifepristone is political. "We look at applications on a scientific basis, and we look at all applications for how products can be used safely," says one FDA official who declines to comment further, citing an agency policy of not discussing drugs that are not yet approved. The Population Council is also reluctant to acknowledge the role of politics. "We're not calling it political in the sense that other people are," says the Population Council's Sandra Waldman, adding that the organization isn't "exactly sure what prompted the FDA to list its requirements."
While no one may know for sure exactly where to pin the blame for the possible restrictions, some have pointed to the influence of the agency's new, more circumspect leader, Jane Henney, and to a general jitteriness at an agency increasingly under siege. A more charitable explanation is that the FDA, known for its scientific integrity, is simply inoculating the drug against anti-choice attacks that are sure to follow its approval.
But, overtly political or not, the proposed restrictions threaten to destroy precisely the most exciting potential of RU-486: to weave abortion into the normal fabric of the medical system. If mifepristone ends up going only to those doctors who already provide abortions, harassment and intimidation can continue unchecked. If, on the other hand, OB-GYNs, internists, and family practitioners who don't already provide abortions start using it, abortion protesters won't know where to take their posters, plastic fetusesand bombs.
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. That's how it was for Amy, a 35-year-old woman who had a mifepristone abortion last October as part of a clinical trial. After taking RU-486 in her doctor's office, she was given a second drug to take at home 24 hours later. When the cramps began half an hour after that, she was in bed with her husband beside her, rubbing her back.
"The pill form allowed me to be in charge of the abortion," says Amy, who adds she would choose it again if she were ever to have another abortion. "Privacy is a lot of it. I like to be able to do this on my own. I don't need doctors to be jeopardizing their lives. And I don't have to be jeopardizing my own life." Amy, who works in a biological laboratory and has a five-year-old son, decided to abort her unintended pregnancy after she realized she had been exposed to some fairly toxic chemicals during the first weeks. Choosing RU-486 meant she could have her abortion as soon as she made the decision, rather than having to wait until she could have a standard, surgical abortion.
overtly political or not, the proposed restrictions threaten to destroy precisely the most exciting potential of RU-486: to weave abortion into the normal fabric of the medical system.
Indeed, mifepristone can be used at the very earliest stages of pregnancy. The drug works as soon as a woman discovers she's pregnant, while the surgical methods most often performed now require waiting until at least the sixth week of pregnancy. The difference can spare a woman the early, uncomfortable days of an unwanted experience. And 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.
Politically, that shift in perception could turn RU-486 into one of the pro-choice movement's most important weapons. Repeated surveys have shown that the American public finds relatively early abortions more acceptable than later ones. Pro-lifers have played on that tension by focusing on abortion procedures that take place in the second and third trimesters of pregnancy. Mifepristone has the power to shove that dialogue back in the other direction. When RU-486 abortions take place, the product of conceptionas doctors sometimes refer to the clump of embryonic cellsis no bigger than a grain of rice.
This swiftness and simplicity also appeal to doctors. According to a recent survey by the Kaiser Family Foundation, 31 percent of gynecologists and 31 percent of family-practice physicians who had not performed abortions within the last five years said they were at least "somewhat likely" to prescribe mifepristone. But nearly half of those gynecologists and 40 percent of the family-practice physicians said they would be deterred from prescribing it if they had to go through a training program, which the FDA may now require.
For Ruth Lesnewski, a physician who works for the East 13th Street Family Practice in the East Village, the restrictions are the deciding factor. "If they come out as they're proposed, I won't be able to offer my patients this option because I'm not fully trained in the surgical procedures they [would] require," says Lesnewski. "Doctors I work with closely would be happy to take care of the failed medical abortions, but the FDA wouldn't consider that adequate."
If restrictions on mifepristone will keep the number of abortion providers down in cities, they will be felt even more strongly in rural areas. The vast majority of rural counties have no abortion providers. Keeping abortioneven medical abortiona secret from local pro-lifers may prove difficult in such rural settings. In 1998 in one Bible Belt town, a single abortion performed with methotrexate (a less effective abortion drug that's FDA-approved for cancer treatment, though not for abortions) caused an uproar that set off a staff resignation, letters from area ministers, and a petition signed by 8000.