In the U.S. debate over RU-486, only two positions have been recognized: anti-abortion activists who contest its use and pro-choice advocates who claim that it will revolutionize the abortion procedure for women. There is a third position: Women need safe, legal abortions, but RU-486 is a problematic and often harmful abortion method.
There are many misleading claims for RU-486. Most people think it is one drug when, in fact, it is two--RU-486 plus prostaglandin (PG). Often, other drugs are added to alleviate the side effects of the first two, thus becoming a sort of "drug cocktail." When used alone, RU-486 averages a 60% success rate in terminating pregnancy. Prostaglandin was added to ensure higher success rates, but brought with it a higher incidence of pain, bleeding, vomiting, nausea and diarrhea. One woman has died of an RU-486/PG abortion, probably of cardiovascular complications linked to the prostaglandin, and a disturbing number of women have experienced bleeding requiring blood transfusions.
Even with the added prostaglandin, RU-486 abortions have a failure rate of 5% to 7%, whereas conventional suction abortion procedures are 99% effective. The prostaglandin must be taken 36 to 48 hours after the initial RU-486 administration, which draws out the actual abortion, with some women not expelling the embryo until days after the prostaglandin treatment. Those 5% to 7% of women who have incomplete abortions or tissue remaining in the uterus must endure a second, conventional abortion procedure.
Often calling RU-486/PG a do-it-yourself abortion, or a pill that can be dispensed in the privacy of a doctor's office, proponents have immensely simplified the complexity of this abortion regimen. Nowhere in the world is RU-486/PG given to women to take at home or even in the privacy of a physician's office. In fact, most researchers and clinicians who work with RU-486/PG admit that to maintain safety, extremely close medical supervision is required.
Those who believe that RU-486/PG will make women, doctors and clinics less vulnerable to anti-abortion harassment should acquaint themselves with the increased confinement of RU-486 to more specialized and monitored medical centers. As the complications of incomplete abortions--heavy and prolonged bleeding, and cardiovascular problems associated with the prostaglandin--have surfaced, further medicalization of RU-486/PG has become necessary. These complications caused France's DMPH, the government drug agency, to issue treatment directives mandating the proximity of electrocardiogram and resuscitative cardiopulmonary equipment, as well as blood-pressure readings every half-hour after prostaglandin administration.
That RU-486/PG would decrease the high number of botched abortions and deaths related to abortion in developing countries has also been a major selling point. But given the strict medical supervision and backup needed, both of which are sorely lacking in developing countries, its use there would be unethical. Add to this the fact that more than 60% of women in many developing countries have persistent anemia, a contraindication for taking RU-486/PG.
RU-486/PG has a growing list of contraindications excluding large numbers of women from using the method. Among them are women under 18 and over 35; heavy smokers; women with high blood pressure, menstrual irregularities, and kidney, liver and lung disorders, and, in some studies, contraceptive pill and IUD users.
RU-486/PG is promoted as "more choice" for women, but "more choice" may ultimately provide less choice at a time when physicians are retreating from conventional abortion practice. Some researchers and clinicians have argued that RU-486 makes conventional abortions obsolete. Indeed, the unfortunate consequence of marketing chemical abortion in this country may well be to make suction abortions obsolete and to promote the present trend of decreasing conventional abortion services. When the complications of RU-486 become more widely known and publicized, American women may find themselves in the position of facing severely reduced access to conventional methods of abortion.
There is another alternative. Train health workers, in addition to doctors, to perform safe, first-trimester, suction abortions. This is the current legal situation in Montana and Vermont; physicians' assistants at the Vermont Women's Health Center perform one-third of all abortions in that state. First-trimester suction abortion is one of the simplest of doctor-performed gynecological procedures, requiring less expertise, training and skill than attending birth. Rather than advocating for one more dubious reproductive drug such as RU-486/PG, feminists and reproductive-rights advocates should be recruiting physicians, family planners and others to help de-medicalize conventional abortion services when it seems to be in the best interests of women and doctors to do so.