Thursday, August 12, 1999
"I''m praying for peace in this clinic and for the protection of the unborn," she says. She''ll continue to pray until she goes back to college next semester, where she will study for her masters degree in theology.
While Bernie prays today outside a clinic that performs surgical abortion, by the end of the year, she may have to also kneel in front of gynecologists'' and family doctors'' offices throughout the community if she wants to pray for the unborn.
After a 16-year battle to make it available here, RU-486, or the "French abortion pill," called mifepristone in this country, may soon be available to American women. If all goes according to plan, mifepristone could be approved by the Food and Drug Administration (FDA) and available to women here by the turn of the millennium, offering women a non-surgical alternative to abortion that can be easily administered by any medical doctor.
"RU-486 would be devastaing" says Koleszar. "It would make abortion easier, and when things are very easy, you often don''t always consider the ramifications of your actions."
But pro-choice advocates are touting mifepristone as a safe alternative to a perfectly legal medical procedure. Nobody, they say, be it Congress, American drug companies, right-wing extremists or the pope, has the right to deny American women the latest in medical technology.
"Women around the world have this option," says Anne Marie Wallace, communications director for California Planned Parenthood. "Meanwhile American women are being treated like second-class citizens. With mifepristone available, at least women would have the option and a choice. Right now, they have no choice, and that''s a problem."
The pope called it the "pill of Cain, the monster that cynically kills its brothers." A Catholic archbishop called it the "murder pill." Pro-lifers refer to it as the "human exterminator" and the "French death pill."
The French health minister has deemed it the "moral property of women," and pro-choicers are calling it the biggest step forward in women''s rights since Roe v Wade.
Indeed, not since the U.S. Supreme Court made abortion legal has an event sparked so much controversy. Why should one little pill cause such bitter debate? Because mifepristone could change everything about abortion--when it''s done, where it''s done, who does it and who uses it.
Currently, medical (drug-induced) abortion is legal and available to women in Sweden, England, France and China. An estimated 300,000 European women and 3 million Chinese women have used mifepristone to terminate pregnancy. But in the U.S., it has only been made available so far to a limited number of women via research trials in a few cities. In 1998, the Population Council in New York, an international nonprofit group that owns the patent rights to the drug, released results of a survey of 2,121 women who had participated in mifepristone research: 90 percent said they would prefer it if they were to have another abortion.
In these trials, women were given three pills totaling 600 mg. of mifepristone, which blocks receptors of progesterone, a key hormone necessary to maintain pregnancy. Two days later, the women were given two pills of a drug called misoprostol, which causes the uterus to contract and shed the embryo.
The procedure is not fun. Medical abortions are drawn out and painful processes involving hours of intense cramping. It can take anywhere from four to 24 hours for the uterus to expel the embryo, and bleeding can last up to nine days. Nausea, headache, weakness and diarrhea are common side effects.
Pro-life activists argue that most of the research on mifepristone (albeit thanks to our elected officials) has been performed out of this country, and women here simply don''t know what they''re in for. "Women are unaware of a lot of the risks involved," says Koleszar. "There''s a lot of bleeding associated with the procedure. The ramifications have not been well-publicized, and I''m concerned in terms of [a lack of] education."
While the procedure is certainly uncomfortable, medical evidence shows it to be safer than surgical abortion. Risks to women are lower because the procedure is non-surgical and because it requires no anesthesia. Out of 300,000 drug-induced abortions in Europe, one death has resulted: A French woman died from a fatal heart attack resulting from complications caused by an injected dose of prostaglandin administered to induce contractions. As a result, in 1992 France replaced the injectable prostaglandin with an oral form used today. And pro-choicers point out that the mifepristone has a better track record than childbirth in North America (one death in 14,300 pregnancies) and illegal abortions (one death in 3,000).
In many ways, the expediency of surgical abortion, which is quicker and often less painful, is preferable. What makes mifepristone attractive for many women is that it can be administered earlier than surgical abortion, from the minute a woman finds out she''s pregnant to nine weeks of pregnancy. Morever, the procedure is non-invasive.
"Medical abortion provides a choice for women," says Sandra Waldman, director of public information for the Population Council. "Some women prefer mifepristone because they feel more in control of their own bodies. It''s really about choice."
For many American women, however, mifepristone offers more than the choice between surgical and medical abortion, it offers access to abortion at all. According to data compiled by Planned Parenthood, 84 percent of United States counties lack an abortion provider.
"The whole thing is about access," says Eileen Tremain, community affairs coordinator for Planned Parenthood Mar Monte in Monterey. "Roe v Wade made it legal, but it doesn''t matter if it''s legal, if women don''t have access to abortion."
With approval of mifepristone, abortions could be administered right in the family doctor''s office, potentially proliferating abortion access beyond the abortion clinic and providing better access, particularly to poor women and women living in rural areas. A survey conducted last year by the Henry J. Kaiser Foundation found that 54 percent of obstetricians/gynecologists would prescribe mifepristone. Moreover, 45 percent of family physicians "expressed interest" in administering mifepristone should it be approved.
Besides that, mifepristone could take the fear and shame out of walking into the abortion clinic. "Mifepristone will make it so women have a better opportunity to make their own choices without interference from religious groups or anyone else," says Lorita Fisher, past president of the Monterey Peninsula League of Women Voters.
While the availability of mifepristone spells good news for women seeking abortions, it will no doubt throw a wrench in the tactics of extremist pro-lifers. "It will force the anti-choice force to change their tactics," says Wallace of Planned Parent-hood. "They can''t go after every ob/gyn, general practitioner and pharmacy."
But, "they''re not going to be daunted," she warns. Pro-life groups have made it clear that, should mifepristone be approved, their efforts will continue with renewed vigor, this time not targeting the doctors and patients, but the drug manufacturers themselves. "They say they are willing to go to the homes of executives," says Wallace. "They''ll be just as confrontational, but with their efforts directed toward executives and businesspeople."
"The extremists have shown they will stop at nothing short of murder to further their political agenda," adds Katherine Spillar, national coordinator for the Feminist Majority Foundation, a pro-choice group instrumental in advancing RU-486 in the U.S. "We''re very worried about that."
Since abortion is legal in this country, one might conclude that a safe and effective alternative to surgical abortion procedure would be legal as well. Think again.
In fact, women have been struggling since 1983, when research trials first began at the University of Southern California, to bring the French abortion pill across the Atlantic, and the pro-life movement is attacking the entry of mifepristone into the U.S. at every turn.
In 1988, just as American pro-choice activists were gearing up to bring RU-486 to the U.S., Roussel Uclaf, the German manufacturer of RU-486, bent to anti-abortion groups in Europe and decided to withdraw the drug from the French market. But the French Minister of Health stepped in and ordered the company to return the drug to the market, calling RU-486 "the moral property of women, not just the property of one drug company." But the next year, Roussel Uclaf''s parent company, Hoechst AG, announced that the company had no intention of marketing the drug outside of France.
In the U.S. during the Reagan-Bush years, RU-486 was classified as a banned drug by the FDA, which effectively halted all federal research. In 1992, the much-publicized arrival of Leona Benten to JFK Airport in New York, RU-486 in hand, brought the medical abortion issue to the forefront in the U.S. Benten''s abortion pills smuggled from Europe were confiscated by U.S. Customs. The U.S. Supreme Court later upheld the confiscation and the FDA importation ban on the drug.
In 1992, President Clinton was elected, and he vowed to bring RU-486 to this country. But the real breakthrough came in 1994, when Roussel Uclaf donated its U.S. patent rights to RU-486 to the Population Council. The drug, now referred to as mifepristone, could finally be marketed in the U.S. But the nonprofit organization still had to find a company to manufacture the drug. There were no takers among American drug companies.
The Population Council eventually teamed up with Danco in 1996, a group of investors formed solely to market mifepristone. Danco found the Hungarian company Gedeon Richter to manufacture mifepristone in the U.S. But Gedeon suddenly backed out in 1997. Now, says Waldman of the Population Council, Danco has found another manufacturer, and approval and release of the drug is scheduled for the end of this year.
Meanwhile, under intense pressure from religious lobbyers, Congress has attempted to halt the advance of mifepristone on American soil through various means. The latest tactic was played out by Rep. Tom Coburn (R-Oklahoma), who earlier this summer introduced an amendment to the House Agriculture Appropriations Bill for the fiscal year 2000 that "prohibits any funds to be used by the FDA for the testing, development, or approval... of any drug for the chemical inducement of abortion."
"There is something terribly wrong when we ask the taxpayers of this country to spend money in a way which is designed to give the Food and Drug Administration the ability to research and approve drugs that are designed to kill unborn children," argued Coburn on the House floor. "This should not be a debate about abortion, and I do not intend it to be. It is about how we use taxpayers'' money and for what purpose should that money be used."
The Coburn amendment, which could mean another year''s delay before the FDA approves mifepristone, passed the House June 8 by three votes. The entire bill passed later in the month and is currently in the Senate, where pro-choice activists are hopeful that the amendment will fail. (Coburn successfully introduced the same amendment in the House last year, but his it was killed in the Senate.)
"This is a typical tactic," Richard Criley, executive director of the Monterey County American Civil Liberties Union (ACLU), says of the Coburn amendment. "You''ve got a Republican majority [in Congress] deeply and profoundly affected by the right-wing, including not only the extreme, right-wing fundamentalists, but the Catholic lobby, who exert a tremendous amount of political pressure."
While conservative congressmen like Coburn have so far been unsuccessful in cutting off FDA funding, "it shows us that we are vulnerable," say Tremain. While Planned Parenthood polls show that 66 percent of Americans support first-trimester abortion, and mifepristone would allow abortion to be conducted earlier than surgical abortion, the current conservative Congress as a whole has done nothing to speed up the approval process. Planned Parenthood data shows that only 32 percent of Congress votes consistently to protect women''s right to choose. And, also according to Planned Parenthood, Congress spent $50 million in 1997 on abstinence-only sex education, but nothing on birth control or AIDS prevention education.
"The overwhelming majority of people in this country support abortion; there is very little controversy at the earliest stages," says Spillar of the Feminist Majority Foundation. "[But] there has been a very vocal and well-funded anti-choice movement that has the ear of most of Congress, who is voting out of step with their constituents. What are these guys doing?"
Among the vocal, well-funded lobbies in Washington, D.C., the Catholic Church has led the fight against abortion drugs. While the fact that mifepristone allows for much earlier abortions may make it more palpable in the minds of the secular population, in the eyes of Catholics and conservative Protestants, who believe life begins at conception, the approval of mifepristone would be another outrage against their struggle to eliminate abortion.
"Whether the Supreme Court has said that abortion is legal," says Ned Dolejsi, executive director of the California Catholic Conference, "doesn''t make it moral. Whether you''re talking about RU-486 or infanticide, from our perspective, you''re still taking a life."