Speaking of Abortion

Speaking of Abortion

The abortion pill

The controversial drug RU-486, known in America as miferpristone, has been availabe in France since 1989, but opposition by right-to-life groups has deterred its introduction into the United States. Just after taking office in January 1992, however, the Clinton administration pushed the U.S. Food and Drug Administration to reconsider the ban on the drug's import.

Two years later, after much behind-the-scenes discussion, the administration announced that Roussel-Uclaf, the pharmaceutical firm that markets the drug in France, would donate U.S. Rights to the drug to the Population Council, a New York-based research firm. In October 1994, the Population Council began clinical trials of the drug at more than a dozen clinics around the country. The trials are designed to determine the safety of mifepristone and to gather data for the FDA as part of the approval process.

The abortion drug is given in different doses, depending on where it's being administered. In France, mifepristone is given as a 600-milligram pill, followed by the synthetic hormone prostaglandin administered orally, two days later. In Great Britain, mifepristone is given orally, and two days later prostaglandin is given in the form of a vaginal suppository. The mifepristone/prostaglandin regimen is used up to 49 days from the las menstrual period in France, and 63 days from the last menstrual period in Britain and Sweden.

The abortion drug works by interrupting pregnancy in the early stages. It does this by blocking the action of a natural hormone called progesterone. Normally, progesterone prepares the lining of the uterus for a fertilized egg. Without progesterone the lining of the uterus breaks down and menstruation begins, resulting in the expulsion of any fertilized egg.

Mifepristone is effective only in the earliest weeks of pregnancy, when the ovaries produce progesterone. By the ninth or tenth week, , however, large amounts of progesterone are also produced by the placenta. The amounts involved are too great for the antiprogrestins, or mifepristone, to block the pregnancy from progressing.

In Europe, an estimated 150,000 women have used mifepristone. Not only can it be used earlier in the pregnancy than a surgical procedure, women have to wait up to six weeks after a missed period before they can have an abortion – but it requires no invasive surgery or anesthesia, and it doesn't carry the risk of uterine perforation or injury to the cervix.

Many women prefer the technique to surgical abortion because it gives them more privacy and more control over their bodies. But some women opt for surgical abortion because it is over faster and requires fewer office visits.

Surgical abortions are also slightly more effective than medical abortions. Mifepristone is 96 to 99 percent effective in inducing a complete abortion. It fails in one in 100 cases and causes an incomplete abortion in three in 100 cases, and if it causes an incomplete abortion, a surgical procedure is required. With a surgical abortion, the woman notices less blood loss and is unaware of the passing of the fertilized egg.

Either way, there will be some side effects. Mifepristone usually causes light bleeding. Some women experience cramps, abdominal pain, heavy bleeding that can last up to three weeks, and, in rare cases, sever hemorrhaging. In France, about 1 in 1,000 women require a blood transfusion because of severe hemorrhaging.

When and if it does make its way to the United States, mifepristone will be provided in private physician's offices, abortion clinics, and hospitals. The cost has not yest been determined, but experts say that it will probably cost the same as a surgical abortion.

Healthy girls. Photo by Elena

Defining limits to a woman's right to terminate pregnancy

A woman's right to elect an abortion remains the law of the land under Roe v. Wade and subsequent Supreme Court decisions. But that web of judicial ruling has left the states free to legislate numerous restrictions on the exercise of that right. A glossary of the different types of restrictions is adapted below from information supplied by the National Abortion Rights Action League.

Abortion ban – The state prohibits virtually all abortions, but the ban in unticonstitutional and therefore unenforceable. In Pre-Roe states, the ban in question pre-date Roe v. Wade. In Post-Roe states, the state has amended and reenacted its pre-Roe ban. Either way, the ban has no legal force.

Informed consent – No abortion is allowed unless a woman receives state-prepared materials and counseling on adoptions and abortion alternatives, is told the doctor's qualifications, and has the risks of the procedure explained to her.

Minor's access – Requires one parent's written consent for a minor under 18. Permits abortion without parental consent if court order indicates woman is well informed and sufficiently mature.

Physician-Only requirement – Only a state-licensed physician  may perform abortion procedures.

Public funding – Regulation that a woman eligible for state medical care can't use such funds for abortion unless her life is at risk.

Viability testing – Bars physician from performing abortion from 18th week on.

Conscience-based exemption – Spares any person or hospital from performing a role in an abortion.

Post-viability restrictions – No abortion is allowed after viability unless necessary to preserve woman's health. In event of such, a second physician is required to provide medical attention to the fetus.

Clinic violence and harassment – Provides criminal penalties for anyone physically preventing an individual from entering or exiting a health care facility.

Husband consent/Husband notice – No abortion for a married woman living with her husband without his consent.

Insurance – No abortion coverage under group health insurance for state workers.

Waiting period – No abortion unless a woman has waited 24 hours after hearing a state-mandated lecture about fetal development, abortion alternatives, and possible effects on future pregnancies.

Legislative declaration (pro-choice) – a law indicating legislative intent to protect a woman's right to choose abortion.

Legislatшve declaration (anti-choice) – A law indicating intent to ban abortion.

Medical abortion – State resolutions in favor of research and trials of RU-486 and other non-surgical abortion.

Public facilities – No use of public facilities to perform abortion services.

Counseling ban – a state “gag rule” that bars state-funded abortion counseling or referrals.