A snapshot of the "abortion pill"

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Registered: 06-03-2007
A snapshot of the "abortion pill"
Thu, 01-24-2008 - 3:50pm

Looks like we haven't been posting many news stories here, guess I'll take that habit up again. Please do offer format feedback - such as if y'all would prefer to have just links instead of entire stories posted, or more international stuff, or more politics, or more medical/technical stuff. I basically put up what I'm in the mood for right now but I'm open to requests.

**As Abortion Rate Drops, Use of RU-486 Is on Rise**

By Rob Stein
Washington Post Staff Writer
Tuesday, January 22, 2008; Page A01

Thirty-five years after the Supreme Court's landmark Roe v. Wade decision, a pill that has largely faded from the rancorous public debate over abortion has slowly and quietly begun to transform the experience of ending a pregnancy in the United States.

The French abortion pill RU-486, on the market since 2000, has become an increasingly common alternative, making abortion less clinical and more private. At a time when the overall number of abortions has been steadily declining, RU-486-induced abortions have been rising by 22 percent a year and now account for 14 percent of the total -- and more than one in five early abortions performed by the ninth week of pregnancy.

The pill, often called "miffy" after its chemical name mifepristone and brand name Mifeprex, also has helped slow the decline in abortion providers, as more physicians who previously did not perform the procedure discreetly start to prescribe the pill.

"The impact and the promise is huge," said Beth Jordan, medical director of the Association of Reproductive Health Professionals. "It's going a long way towards normalizing abortion."

When the Food and Drug Administration approved mifepristone in 2000, some predicted it would revolutionize the abortion experience and debate by enabling women to get an abortion from any doctor, neutralizing one of opponents' most potent strategies -- picketing abortion clinics.

"The thinking initially was that this was going to change everything. There was a lot of hype. That didn't pan out," said Carole Joffe, a professor of sociology at the University of California at Davis. "But the impact has been happening gradually as it slowly and steadily is becoming integrated into the medical system."

Judi Gilbert, 41, a nurse in Philadelphia, opted for mifepristone in 2005 when she had her second abortion. She had a 3-year-old son and was about to start a new job.

"It was something I could do at home and be with my husband," Gilbert said of taking the pill. "It was a decision we made together alone, and we were able to take care of it this way alone. It was just a much more private affair."

She added: "I wouldn't say it was easy -- it's never easy to terminate a pregnancy. But in the grand scheme of things, it was much more pleasant than a surgical procedure."

Gilbert is one of more than 840,000 U.S. women who have used mifepristone since it was approved, according to Danco Laboratories, which sells it.

The drug ends a pregnancy by blocking the hormone progesterone. Women take the pill in the doctor's office and then go home, where they take another drug, misoprostol, to trigger contractions, essentially causing a miscarriage. Women then return to the doctor within about two weeks to make sure the process worked.

The price of the procedure varies. Standard abortions typically cost about $400, and the pill can cost the same to about $100 more.

About 150,000 of the 1.2 million abortions in the United States in 2006 were done with medication, the Guttmacher Institute, a nonprofit reproductive-health research organization, estimated recently.

More than half of abortion providers now offer the option, a 70 percent increase from the first half of 2001, Guttmacher said.

"Mifepristone is clearly starting to become an important part of the abortion provision in the United States," said Lawrence Finer, who studies the drug at Guttmacher. "I think we'll continue to see increases."

He noted that in some European countries, more than 60 percent of abortions are performed with the drug.

The increase is alarming to abortion opponents, who are expecting thousands to gather in the District today to protest Roe v. Wade on its 35th anniversary.

"This troubles me," said Randall K. O'Bannon of the National Right to Life Committee. "It obviously shows that the marketing efforts have been effective in getting doctors to introduce this into their practices."

O'Bannon questioned the drug's safety, citing a handful of reports of women who have died from severe complications from bacterial infections. "The idea that doctors are beginning to offer something that has a record of causing some serious problems is very troubling," he said. Supporters say that it remains unclear whether the complications were related to the drug and that overall the method has been shown to be extremely safe.

"The availability of mifepristone gives women another safe and effective way to terminate a pregnancy," said Vicki Saporta, president of the National Abortion Federation, which estimates that 83 percent of its 400 member clinics offer the drug.

The increase in mifepristone use has been fueled in part by more doctors and clinics that previously did not perform abortions now offering the drug. Guttmacher identified at least 119 and said those practices have slowed the decline in abortion services. The number of providers fell 2 percent from 1994 to 2005 -- a much slower decline than before the drug became available. Without mifepristone, the drop would have been 8 percent.

Ruth Lesnewski, a family physician in New York, did not perform abortions until mifepristone was approved.

"It allows abortion to happen in a more private, secure setting -- a doctor's office and a woman's home, rather than an easily targeted clinic," she said. "It's been a surprisingly smooth and rewarding experience for such a fraught area of life. My patients really tremendously appreciate being able to end an unwanted pregnancy privately and quickly."

Other doctors have begun to offer mifepristone in addition to surgical abortion.

"For some women, they like to have a more active role rather than just having something done to them," said Deborah Oyer, a family-practice doctor in Seattle. "For some, it feels in some ways more natural because it feels more like their body is doing it."

Some doctors walk a delicate line. One doctor in Albuquerque, for example, said she does not use in the pill at one of her offices but does offer it along with standard abortions at a clinic where she works. At another clinic, she provides only the pill.

"My office is in a politically charged part of the community, so I try to be as diplomatic as possible," she said, speaking on the condition of anonymity. "But at my other office, we can do an abortion where no one has to know -- not even the support staff."

The proportion of abortions being done with the drug varies widely, with some providers saying mifepristone accounts for about 10 percent and others reporting it accounts for two-thirds.

"We see 10 to 12 patients a week who want it," said Mary Frank, who runs the Memphis Center for Reproductive Health. "I've noticed that the women who want this have really done their homework. They know exactly what the process is and really have made a very conscious decision about their choice."

Women's experiences also vary widely.

"Some women say, 'It's the most horrible thing that ever happened and I'll never do it again,' and some women say, 'Heck, my period was worse than that,' " said Catherine McKegney, a family physician in St. Paul, Minn.

Mary, 25, an office administrator in Seattle, opted for mifepristone in December when she became pregnant and decided with her fiance that they were not ready to become parents.

"I liked the idea of being more in control," said Mary, who asked that her full name not be used. "I had some really, really bad cramps and had to take some Vicodin and ibuprofen to calm them down. But other than the cramps, it was pretty painless."

Victoria Reyes, 24, used mifepristone in 2006 when she became pregnant just before she was about to graduate from Ohio State University.

"It was one of the most difficult decisions I ever made in my life," she said. "My boyfriend and I got together and decided we were not in any position to financially afford a child. I chose it because it seemed like a more natural way."

But Reyes was surprised by how physically traumatic it turned out to be.

"It was one of the most painful experiences I've ever had," she said. "Not only were the cramps really bad, I was sweating and had a headache. I threw up at one point. It was pretty bad."

Reyes also had to take a second dose when an ultrasound showed she had not completed the abortion, requiring her to return to the clinic for a second time to confirm that the process was complete.

"I think I'm still glad I picked it," Reyes said. "I just wanted to be home and keep it private."

iVillage Member
Registered: 03-26-2003
Fri, 02-15-2008 - 9:07am

Ah, wobit!

iVillage Member
Registered: 06-03-2007
Fri, 02-15-2008 - 12:13am

I see sound reasons in the previous three posts.
The cantankerous part of me immediately tries to find a reason to support the other view... here's a pretty good one!

Increasingly, mifepristone may be available earlier in the pregnancy than a D&C, which requires a visible sac. I have now heard of providers who are providing mife abortions to women who are known to be wicked early, with good follow up around the time that an ectopic would become visible/diagnosable. We all know that the earlier the termination, the safer it is for the woman. Personally, I feel that the earlier the termination, the less tragic. Mife can also be given in low doses for effective EC... I would love to see that line cut fine, between insanely early abortion and EC.

With the possibility of this super early method being a standard by the time my daughter is ovulating, I think I'd prefer that kind of mife abortion to a D&C. Do I get to make up my own choice?

Also, mife is a drug that I hope would be only ever be available under a dr's care...currently a woman must agree to follow up and undergo a D&C if the mife fails. Mife is NOT something that people are scoring on the street, unlike cytotec and other pills women are using to self-abort clandestinely, without the care of a physician.

Edited 2/15/2008 9:57 am ET by wobitnobby
iVillage Member
Registered: 04-10-2003
Thu, 02-14-2008 - 10:14pm
Definitely the D&C~ With both of my miscarriages, I never fully expelled the remains. In fact with my first, despite having a D&C, some fetal and/or placental fragments were not completely curretted out, and I hemorrhaged for 7 weeks - taking ergotrate to try to get the uterus to clamp down- before they did another D&C. The second miscarriage, the embryo died at 7½wks by u/s dating, but I carried it until I was 11 wks with barely any spotting. IT as only the u/s at that point that showed the dead embryo- and then they did the D&C. But I had been sick for about a week- not knowing why I had a fever and felt SOOOO crummy. It was a low-level of toxins form the whole thing is what they told me. SO yeah- I would want her to have a D&C and be under doctor's care.


iVillage Member
Registered: 10-17-2006
Thu, 02-14-2008 - 9:30pm

RU486 isn't available in my country (the trials were suspended when someone died from septic shock).


iVillage Member
Registered: 06-17-2007
Thu, 02-14-2008 - 9:06pm

I have a question on this for the PC's out there. The recent debate over having a young daughter get pregnant and want an abortion made me think about the availability of this drug.

I'm pretty solid in my feelings that I would not encourage my daughter to have an abortion- it would be up to her. Yet, if she were to become pregnant at the age of 13 or 14 (not unheard of in DH's family), I really doubt I would encourage her to carry the pregnancy unless she really, really wanted to. So I started thinking about the method.

I don't know that I'd feel comfortable having my daughter take RU486 to have an abortion that young, simply because I'd be too worried about her hemorrhaging or being very scared with no one with expert medical training on hand to help. I would certainly be there every step of the way but my Girl Scout first aid training is pathetic if someone is bleeding out. I think I'd be much more comfortable with helping her have a D&C.

So, if you had a daughter who got pregnant quite young and she wanted to have an abortion, which method would you encourage her to take?

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iVillage Member
Registered: 06-03-2007
Thu, 02-14-2008 - 11:46am

Here is one bloggers' opinion piece in response to the recent spate of articles on mifepristone. No one I know. I found it to be... inflammatory... thought provoking ... thought it might spark some posting here. I certainly don't support the inflammatory language but I felt the points were interesting enough it was worth pasting in.


Private RU-486 Confounds Anti-Abortionists: Who Can We Harass Now?

By Sara Robinson, Group News Blog
Posted on February 14, 2008, Printed on February 14, 2008

Don't look now, but the front lines of the abortion battle are shifting. Thanks to advances in medical technology and the introduction of the drug mifepristone (aka RU 486), which gives women the option of having safe, early abortions in private locations instead of public clinics, the raving crazies who tape pictures of bloody fetuses to their bodies, stalk Planned Parenthood and howl "murder" at anyone who walks through its doors, may suddenly find themselves all dressed up with nowhere to go -- and no one to terrorize.

Or, at the very least, if this mob of screeching would-be fetus rescuers wants to continue its brand of guerrilla warfare -- a decades-long face-down with abortion providers who have accepted the possibility that they'd be blown up at their desks or taken out by a sniper while sitting at their dinner tables as just another part of the job -- its self-righteous, lunatic members will have to work a lot harder.

It's about time. Because, judging from the religious right's30-year campaign of violence against U.S. and Canadian medical clinics, I'd say murder in the name of God hasn't been too difficult. Here's a look at domestic terrorism by the numbers:

7 murders, including 3 doctors, 2 clinic employees, a security guard, and an escort

17 attempted murders

383 death threats

153 incidents of assault and battery

3 kidnappings

41 bombings

173 arsons

91 attempted bombings or arsons

619 bomb threats

655 bioterror attacks (all hoaxes), 554 of which were committed by one man

1,630 incidents of trespassing

1,264 incidents of vandalism

100 attacks with butyric acid stink bombs

One-third of all abortion clinics in 1981 were gone by 2005.

If Islamic Jihadists had done even a tenth this much damage, every last Muslim in America would be doing stress-position calisthenics in a concentration camp somewhere in the Nevada desert right now. But since this impressive achievement in domestic terrorism was almost entirely accomplished by white Christian men -- well, y'see, it's Not Terrorism when we do it -- the public has barely batted an eye.

In fact, while most of the country was looking the other way, that's when the supply lines for abortion shifted. According to a recent article in the Washington Post, that change -- RU-486 -- is starting to make a fundamental difference in the way abortion happens -- and is talked about -- in this country.

According to the Post's Rob Stein:

“At a time when the overall number of abortions has been steadily declining, a new survey reported that RU-486-induced abortions have been rising by 22 percent a year and now account for 14 percent of the total -- and more than 1 in 5 of early abortions performed by the ninth week of pregnancy.”

It's not the actual numbers that are interesting here; it's the trendline. RU-486 has been available in the United States since 2000, and its use has been increasing at a slow but steady rate ever since. What's new is that it's finally approaching critical mass, gaining acceptance with the vast numbers of doctors who've wanted to offer their patients the option of a safe early abortion, but simply couldn't take on the daunting social, financial or physical risks of performing the operation themselves. Increasingly, year by year, RU-486 has allowed more and more of these doctors and their patients to do a complete end-run around the crazies at the clinic door. And this has gone on long enough now that it's starting to change the way we approach the whole issue, on several fronts.

First, it's already putting more abortion providers back in service. For 20 years, the number of doctors and clinics offering abortion was in free fall: Every year, it seemed, more of them succumbed to anti-choice harassment and pressure, and closed their doors. Old doctors retired; young ones were discouraged from learning the procedure; clinic directors balked at the PR and security problems and the insurance premiums. But, according to the Guttmacher Institute, the rate of decline suddenly flattened from 8 percent to 2 percent in 2001, as doctors started adding RU-486 to their practices -- and that rate has held steady ever since. We're still losing abortion providers, but most of those losses are being offset by the growing number of doctors offering drug-induced medical abortion. Even better news: Those doctors are now everywhere, including states where the last surgical abortion provider was run out years ago.

Second, it's changing the way women experience abortion. Medical abortion gives women the dignity of going through the process in the privacy and comfort of their own homes, rather than having to hunt down a clinic, get themselves there, and face down the hysterical, pleading mob massed around the clinic doors both before and after enduring a painful and invasive surgery. Also: Most late abortions are necessary only because women are forced to wait too long while they arrange the funding, access or logistics for an expensive, often too-far-away surgical abortion. Mifepristone greatly reduces the expense and hassle -- and, with it, the unnecessary delays that lead to most later-term abortions.

Third, unlike most drugs, RU-486 is dispensed directly by doctors -- which also cuts out of the loop moralizing pharmacists who see women's most essential life decisions as a sort of moral gym equipment on which to freely exercise their underdeveloped consciences and score some extra Jesus Points in the process. (A lot of these same people can't be trusted to hand out birth control pills or Plan B, either -- and if the pharmacy profession can't get these people to fulfill the terms of their licenses, RU-486 is the precedent from which to argue that we should seriously consider putting these other controversial items back into the hands of doctors as well).

Fourth: As medical abortion becomes the norm, women aren't such easy pickings for the religious right any more. You can't just hang out in front of the clinic on Tuesdays and Thursdays and assume everyone coming up the sidewalk is a slutty, bamboozled, callous-hearted, baby-killing bitch who just doesn't understand that it's a baaayyybbeee, that she has options, and that Jesus loves her.

Increasingly, women seeking an abortion are bypassing the clinic entirely. Instead, they're showing up for regular appointments, on all days of the week, at doctors' offices all over town. Which makes it hard on the berzerkers: After all, there's no legitimate way of knowing which doctors are in the abortion business now, or why any individual woman is seeing any given doctor on any given day. Our culture has strong, long-standing customs protecting discussions between doctors and patients, and as abortion increasingly slips behind that wall, that decision is finally ending up exactly where we've always argued it should be -- as a private matter between a woman and her doctor.

When that happens, the question becomes: Will the anti-choice terrorists respect that wall -- or will they try to go over it, get around it or simply blow it up?

What's likely to happen -- because it's what usually happens when radical groups are driven to the fringes -- is that the moderate members who make up the bulk of the movement let go and move on, leaving a much smaller fanatical core to carry on. Without that moderate influence to provide a constant, tempering reality check, the craziness level heats up and becomes concentrated. The remaining True Believers have wrapped up their lives and careers in the fight. For these professional warriors, losing control of the battlefield -- in this case, losing control of women, and the presumed male prerogative to control women's fertility -- may prove to be a fate too shattering to contemplate.

When this kind of defeat and isolation happens, we're usually wise to expect trouble. They'll probably never give up on Planned Parenthood as the all-time all-star Personification of Absolute Evil in their perfervid little cosmological drama, but when abortion vanishes behind a wall of privacy, we can expect to see newly focused attempts to breach the wall of doctor-patient confidentiality, using every means at hand.

They're already at it, as those who've been following the exploits of former Kansas attorney general Phill Kline can tell you. (Kline used his office to harass the state's abortion doctors, requiring them to give up their case records to state review -- a step that would have outed tens of thousands of women who'd had abortions). This is a preview of what doctors will be in for: Escalating attempts to use the law (or simple spying) to discover their treatment choices, open their files, and put their patients' data on public record. We'll see increased use of medical oversight and disciplinary boards to harass doctors and compile lists of women who've had abortions. To the degree this succeeds, it will set terrible precedents that will jeopardize everybody's right to the confidentiality of their own medical records.

And, with those lists in hand, they could -- for the first time -- start going directly after women. In medical abortion, the agent of termination is not surgical instruments in the hands of the doctor in an office, but drugs in the hands of the patient at home. That fact literally puts the event far more directly under women's control -- a shift that may finally force these fanatics to fully reckon with the fact that women are ultimately the responsible moral agents in every abortion decision. And if they do make this leap, we can expect it to get very nasty indeed as the personal becomes political on a whole new level. Our increased privacy could be met with overwhelming publicity: websites, public flyers, picketing in front of our houses, harassing phone calls to employers and family members. The more private the choice becomes, the harder they might fight back by trying to make it as public as possible.

When the frustration builds to the point where violence comes, it could appear on that same front as well. In the past, anti-abortion terrorists bombed clinics because "that's where the babies die," and shot doctors because they were "the real murderers." In the future, that same logic may lead them to bring the gasoline and bombs to the new "abortion chambers" -- that is, our own private homes -- and direct their rage at the new "murderers," now recognized as women themselves.

From there, it's easy to step off into truly frightening images culled from The Handmaid's Tale. That's one possible outcome to be aware of; but, luckily, it's far from the most likely one. More likely, public revulsion at these outrageous privacy invasions and violent tactics will be their undoing -- putting the anti-choice movement in such bad odor that it will lose all of its credibility and most of its cultural support.

We'll know we're getting close when the conventional wisdom accepts that "pro-life" is exactly the equivalent of "pro-snooping-in-your-family's-business"; that "saving babies" is usually a self-righteous bully's excuse for harassing and assaulting women; and that "anti-abortion violence" is, precisely, the modern definition of "domestic terrorism."

RU-486 is, still slowly, shifting the public conversation about abortion. As that new discussion opens up and grows louder, it will also change the ways in which pro- and anti-choice people interact. And -- if we watch for it -- it may give us our last, best chance to return the entire subject to the private sphere, where it ought to be, once and for all.

Sara Robinson is a 20-year veteran of Silicon Valley and is launching a second career as a strategic foresight analyst. When she's not studying change theories and reactionary movements, you can find her singing the alto part over at Orcinus. She lives in Vancouver, B.C., with her husband and two teenagers.

iVillage Member
Registered: 08-31-2004
Sat, 01-26-2008 - 4:50am
I would definitely choose this option over a surgical (correct term?) abortion, and you make a very good point about disguising it in abusive partner/family scenarios.

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baby siggy
iVillage Member
Registered: 06-03-2007
Thu, 01-24-2008 - 4:03pm
The thing that makes me happiest about this is that it means a greater proportion of abortions are being performed even earlier. I read on a listserv I'm a part of that *some* (currently very few) (but it's only been here in the US for 7 years) abortion providers feel comfortable providing Mife abortions before they can see a gestational sac - whereas in order to provide a surgical abortion one must wait until confirming that the pregnancy is not ectopic, which can't be done until the sac can be seen, circa 6 weeks depending on how state-of-the-art the ultrasound machine is. So as Mife becomes more available, we can decrease the average gestational age further. Plus some women grieve the abortion more easily in the privacy of their home, with their partner. Or can disguise their abortion as a miscarriage in the setting of an abusive partner or unsupportive family.