Friday, September 29, 2000
Questions, answers about the abortion pill
By Tim Bonfield
The Cincinnati Enquirer
Question: What is RU-486?
Answer: RU-486 is a compound that blocks the action of progesterone, a key hormone needed to maintain a pregnancy. It was developed in 1980 by the French drug company, Roussel Uclaf. The drug was later given the generic name mifepristone.
Q: How does it work?
A: In a woman's body, the natural hormone progesterone is essential for establishing and maintaining a pregnancy. RU-486 is a progesterone antagonist, or an “antiprogestin.” By blocking the action of progesterone, the drug causes a woman's uterus lining to break down and shed as during normal menstruation. The drug also opens the cervix and triggers contractions that expel the embryo.
By itself, the drug is not a highly effective abortion pill. Stud ies mostly conducted in Europe report that following up with a dose of prostaglandin makes the regimen more than 95 percent effective at inducing abortion.
Q:Where is it used?
A: RU-486 was approved in France in 1988, in England in 1991, in Sweden in 1992 and in at least 10 European countries since then. It also is used in China and Israel. Over the years, more than 620,000 European women have used the abortion pill. In 1994 and 1995, a few thousand American women participated in small-scale clinical trials of the drug.
Q: What are its advantages?
A: The biggest reason for using an abortion pill would be to avoid a surgical abortion, which carries more potential risk to the woman. Even though the pill would require more follow-up physician care, RU-486 would be a cheaper option than surgical abortion.
Depending on how widely it is prescribed, the drug also could make abortions easier to get for women who live long distances from abortion clinics. It might also allow more women to avoid encounters with anti-abortion protesters who picket clinics.
Q: What are its risks?
A: The drug should be used only during the first seven weeks of pregnancy, and will not work if a woman has a tubal or ectopic pregnancy. Both situations may require testing to establish.
In addition, women should not be using an IUD contraceptive device; taking blood thinners or corticosteroids; or have chronic failure of the adrenal glands.
Even when used at the right time, the drug is not perfect. In clinical studies, incomplete abortion occurred in 2 percent to 3 percent of cases and pregnancy persisted in 1 percent. These women then required surgical abortions.
The most common side effects are similar to those of a spontaneous miscarriage: uterine cramps, bleeding, nausea and fatigue.
About 1 percent of women who take the drug combination experience heavy bleeding, which requires further treatment.
Q: When will it be available in the Tristate?
A: Could be available to coctors within a month.
Q: How will women get it?
A: Women must find a doctor who is willing to prescribe the drug and meets restrictions listed by the FDA, which include: the ability to accurately detect a tubal pregnancy and making advance arrangements to provide surgical intervention in case of severe bleeding or incomplete abortion. In addition to abortion clinics, many practicing obstetrician/gynecologists would be able to meet the FDA standards. How many ob/gyn groups would be willing to prescribe RU-486 remains to be seen.
Q: Can states ban it or at least impose restrictions?
A:In general, state-imposed restrictions on surgical abortion, such as Ohio's parental notification rules, would apply to medical abortions using RU-486. An outright ban might not stand up to court challenge. Historically, FDA approval of a medication has pre-empted state restrictions.
Q: How much will it cost?
A: Unknown.
Q: Will insurers cover RU-486?
A: Perhaps. Some insurers that already cover abortion procedures will likely cover RU-486. At ChoiceCare/Humana, which covers abortions if the benefit is approved by the employer group, the new pill must go through a medical committee review before it can be listed on its drug formularies. However, the history of private coverage for reproductive services has been mixed. Some insurers will pay for birth control pills and devices along with some infertility treatments. Others have refused to cover such services, arguing they are not medically necessary.
Bottom line: Check with your insurer.
Sources: U.S. FDA, the Center for Reproductive Law & Policy, the Life Issues Institute (based in Cincinnati), Planned Parenthood, Childbirth by Choice Trust (Toronto Canada); and the California Abortion & Reproductive Rights Action League
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