Hard pill to swallow

During last month’s media fanfare surrounding FDA approval of the abortion pill, RU-486, Planned Parenthood president Gloria Feldt reported that women in the clinical trials said such medical abortions felt more natural than surgical ones: These women "feel more in charge, more in control of their personal health," Feldt says (New York Times, September 29).

Does this bit of rhetoric show any interest in addressing the issues of control that bring women to abortion? No. Does it accurately reflect what women said in clinical trials? No again. In fact, some were distressed by the experience: initially there is intense cramping, and then nine-to-sixteen days of bleeding; above all, women were shocked at seeing the sac, the placenta, and, in more developed pregnancies (the approved RU-486 cut-off limit is seven weeks), hints of human form.

Among women who had a prior surgical abortion, reports were mixed. Some preferred the RU-486-induced abortion because it felt less invasive than the surgical one: there were no instruments or noise from the suction machine. One of the women did express puzzlement at the use of the word natural, however: "Natural? That is baffling to me. To me it seems incredibly unnatural."

Some of those who preferred surgical abortion did so on pragmatic grounds: a surgical abortion requires one trip to the doctor as opposed to three; and it is over in a few hours. For some, there was a clear cognitive difference between the two methods, "you really confront what you are doing [with RU-486]. It was a little overwhelming to see. If you have any doubts about having an abortion, I think it would be difficult. With the surgical method, you lie there and it’s done."

European statistics support this ambivalent reaction: In Sweden and in France, where RU-486 has been used for a decade, fewer then one-quarter of abortion-seeking women ask for the drug. In Britain, 93 percent of women who have had a medical abortion say they would do so again. But only 6 percent actually choose RU-486. In none of these countries has the advent of the drug increased the overall number of abortions.

If Gloria Feldt’s sloganeering glosses over some of these difficult realities, The National Right to Life Committee’s attack on RU-486 as unsafe for women is equally unconvincing. Such abortions may or may not be more difficult for women, but they certainly appear to be safe.

Will RU-486 change the American abortion landscape? That is hard to predict.

Anecdotal and statistical evidence suggests that, as in Europe, surgical abortion will remain the prevalent choice. While it was initially expected that more doctors in the United States would be willing to provide RU-486 abortions than perform surgical abortion, a Pittsburgh doctor training his colleagues in the use of the drug, reports that initial interest drops rapidly when doctors learn of FDA requirements about its use: the number of patient visits along with state rules about abortion registration, fetal tissue disposal, and even the technical design of doctors’ offices.

What has changed, since the RU-486 clinical trials began, is that abortion clinics, as a result of new techniques, have been providing vacuum abortions earlier than seven weeks. Could it be that RU-486 has and will continue to bring pressure on those who provide and those who seek abortions to do so at earlier and earlier dates? That would bring abortion providers in line with the majority view in the United States that later abortions are more morally repellent than earlier ones.

And abortion seekers? They certainly need support in gaining a stronger sense of control, before they get pregnant. How to achieve that requires a fuller and more honest public conversation-about personal responsibility, birth control, the long-term effects of abortion, family policy, and sexual politics-than we have heard thus far.

Published in the 2000-10-20 issue: 
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