PERSPECTIVES ON THE ‘ABORTION PILL’ : RU-486: Liberation or Nightmare? : The benefits to women in low-income nations won’t be known without more research and less political meddling.
The development of the medical abortifacient pill mifepristone, popularly known as RU-486, is by scientific measures a breakthrough. But science cannot function in isolation from the realities of today’s world. And in today’s world, millions of women are living in low-income countries suffering from unprecedented economic crises and deteriorating health systems. Women in these countries are increasingly losing what little power and rights they had when their own traditional societies were more stable. What are the implications of this new technology to women in these countries?
Western feminists and some scientists in developing countries hail RU-486 as a revolutionary drug. They see it as liberating women from unwanted fertility, oppressive anti-abortion laws and policies, dependence on health providers and on less effective and more dangerous methods to terminate unwanted pregnancy.
Others take a more cautious position; they warn against untimely introduction to less-developed countries of a new technology that has not been developed enough to suit the social and economic limitations of the majority of poor women. Their concern is that, in its present form, RU-486 use requires more reliable health services than most developing countries can offer.
There is some justification for both positions, and their proponents could push for the development of improved medical abortifacients if they joined their efforts.
RU-486 is a very promising drug. When taken alone, it is about 65% effective in early pregnancy and has negligible side effects. Until recently, it needed the supplementary use of an injectable synthetic hormone, prostaglandin, to increase its effectiveness rate to over 90%. The prostaglandin necessitates repeat visits, is difficult to store in hot climates and could cause serious side effects.
Research suggests that equally high effectiveness could be achieved with a combination of RU-486 and another widely used form of prostaglandin, with fewer side effects. This combination, taken orally, could reduce the number of doctor visits and the complications of injectable prostaglandin. These considerations are particularly important for women who live in areas where transportation and communication systems are unreliable, and access to appropriate health facilities is limited.
Although most women who used RU-486 report a sense of autonomy and less control by the health provider, medical abortifacients cannot be administered without supervision. The ultimate goal is to develop a highly effective, low-complication, one-visit, inexpensive medical abortifacient that enhances women’s choices and reduces their reproductive risks. This hasn’t happened yet; more research must be done, both in developed and in selected developing countries.
For many developing countries, the advantages of medical abortifacients over surgical abortion could be substantial. They may prove cheaper and less demanding of health personnel’s time and could free surgical facilities for other uses. In countries where there is a higher risk of infections, including AIDS, non-invasive treatments are preferable to surgical procedures. However, the need for backup surgical facilities will remain.
What, then, is the economic, social and political climate within which RU-486 and other abortion technologies will function? Under current circumstances, certain precautions must be taken or the potentially liberating drug could become a nightmare. The economic pressures on people to earn money however they can, together with restrictive abortion laws, will undoubtedly create a profitable black market in the drug as soon as it is more widely available.
The French manufacturers are carefully limiting RU-486’s distribution to licensed hospitals in developed countries and research institutions. But their patent on the drug will run out one day, and other companies in different countries will be able to produce it in mass quantities at a reduced price. Although RU-486 is a low-risk drug, and certainly safer than home-induced or back-street abortion, its use without proper information and with no backup services could prove dangerous.
Training and information about administering RU-486 must be given to as many providers as possible. And women themselves must receive information on safe and appropriate use to reduce the risk of misuse or misinformation given by profit-motivated abortion providers.
To ensure such favorable handling of RU-486, there are immediate steps to be taken. More research and trials should be conducted on a wider scale than is currently allowed by the manufacturers and governments, notably that of the United States, to achieve the simplified appropriate combination of drugs needed for use in developing countries.
Technology will not solve the problem if unwanted pregnancy is not recognized as a social and health issue and if abortion is not offered with full legal, financial and social support. RU-486 can turn from a scientific tool for women to improve the quality of their lives to a fugitive and illegal drug, dangerous and destructive to health. Medical abortifacients must be used judiciously in conjunction with other measures to tackle the causes of unwanted pregnancy and with legal and policy reforms that would increase access to abortion services.
That second condition is very difficult to achieve when the largest donor to family-planning and health programs, the government of the United States, has imposed a ban on abortion services and counseling by recipients of its international assistance.
The policy of the United States toward abortion in general and RU-486 in particular currently jeopardizes millions of women’s lives. What is needed is a return to the earlier, more humane U.S. policies toward safe abortion services within family-planning programs and a supportive role toward the needs of women in low-income countries.
