News reports about the FDA's decision to approve RU-486 have been all over the map, but one thing nearly everyone in the press seems to hope is that the availability of the abortion pill will take the issue out of politics.
When people say that, it sounds so reasonable, so neutral. But what they are really saying is, "Maybe this will silence those annoying pro-lifers." Even the Supreme Court once pronounced that abortion foes should simply shut up. Hadn't the Supreme Court decided the matter?
But, of course, if this issue does not belong in the political realm, what does?
The Food and Drug Administration has now joined an Orwellian world in which words mean their opposite. By statute, the agency must find before approving a drug or device that it is "safe and effective." Manufacturers of other drugs approved for use by pregnant women must prove that the medicine will not harm the fetus. In the case of an abortion pill, things get confused. Mifepristone (RU-486) can rid a woman of an early pregnancy, so it is mostly safe for her (we'll return to this subject in a moment), but it is obviously anything but safe for the fetus. This did not give the bureaucrats at FDA any pause.
As for those who hope that the introduction of this drug (actually two drugs) will end the debate about abortion -- not likely. Taking Mifepristone is not like popping a Tylenol or even like taking the combination of drugs known as the "morning after" pill.
Let's start with the basics: No pregnancy ends without some pain, some risk to the mother and some blood. A very early natural miscarriage is the least traumatic to the mother. But as soon as the pregnancy has taken hold for a few weeks, ending it -- naturally or through abortion -- is not a simple or easy matter.
The first stage of Mifepristone is an anti-progesterone drug that causes the lining of the uterus to break down. The loss of the lining leads to bleeding. The next stage of the drug contains prostagladin, a hormone that causes the uterus to contract. In effect, prostagladins produce a miscarriage. During this phase of the "medical abortion," bleeding and cramping can be severe, and associated with diarrhea and vomiting. The bleeding is actually more profuse than that associated with surgical abortions, and in about one in 500 cases, women require a trip to the emergency room and blood transfusions. There are also about 5 percent of women whose pregnancies are not completely ended by these drugs, and these women require a surgical abortion to finish the job.
The whole course of the medical abortion is three days. That's a long time to spend in pain.
Because the drug is potentially dangerous to the mother, close medical supervision is required. It is also imperative that the doctor who dispenses these drugs be able to determine, through ultrasound, that the patient does not have a tubal pregnancy. Doctors will also discover, as the New York Times pointed out last week, that becoming an "abortion provider" will subject them to myriad regulations; some will have to provide pre-abortion counseling, others to notify the parents of underage girls.
In many states, abortion providers are subject to regulations on how wide the hallways of their offices must be, how hot the water from the tap may be, and the how much air flow circulates. Several states require that fetal remains be examined. One state requires that fetal remains be buried. Many physicians might just beg off.
Use of this new drug also requires a high degree of body awareness on the part of the woman. The drug is safe (for the mother) only until the 49th day after the start of the last menstrual period (or about 35 days after conception). This may cause confusion, particularly with young pregnant girls who have trouble facing up to the fact that they are pregnant. Mifepristone permits only about a 3-week window for girls to make up their minds. Many will miss the mark and wind up at the abortion clinic just as before.
So RU-486 will not end the debate, nor will it make the issue simply go underground, as many seem to hope. The moral question will stay with us and continue to divide us.