Rethinking the Abortion Pill

Last Thursday, the Food and Drug Administration (FDA) made the landmark decision to approve RU-486--otherwise known as "mifepristone"--for use in the United States after almost twenty years of deliberation and testing in the midst of roiling controversy. First available in France in 1988, and now used widely across Europe and China, the pill provides an alternative to surgical abortion by chemically inducing miscarriage. Although RU-486 can currently be prescribed only at special clinics and designated hospitals, the drug will soon become available to practitioners across the country.

As might be expected, the pro-life camp responded to the announcement with an immediate outpouring of anger and outrage. Many of the comments were particularly critical of the perceived increase in accessibility to the procedure that the pill will provide: Chair of the House Republican Committee J.C. Watts

(R-Okh.) railed that "do-it-yourself-abortion has no place in civilized society." Others stuck to simpler, more familiar catch-phrases, with Rep. Christopher Smith (R-N.J.) calling RU-486 "baby poison" and Rep. Tom Coburn (R-Okh.) claiming that the FDA's decision was making available "a drug intended to kill people."

But across the aisle, where one would anticipate an equal and opposite reaction of elation, the FDA's decision has left many pro-choice advocates strangely unsatisfied. For although RU-486 has been completely cleared for public consumption, that clearance is tampered with a long list of restrictions that pro-choice supporters claim reduce its effectiveness for those who would wish to use it. These advocates assert that the stipulations that the FDA has placed upon the pill will serve to counter the majority of the pill's positive effects.

The pill can only be used in the first 49 days of pregnancy, making it an effective option only in a small percentage of cases. It can only be administered by practitioners who ensure that a surgical abortion will be available on the rare occasion that the pill fails, thereby virtually limiting the number of doctors who can dispense the drug to the same number who already perform abortions. Moreover, physicians wishing to prescribe RU-486 must comply with a broad range of often archaic state laws regulating surgical abortions; laws whose stipulations are often difficult to apply to this radical new approach to the procedure.

A cry has gone out, then, to ease the guidelines regulating the use of RU-486 so that the procedure can be used to the benefit of a larger percentage of the population. Their arguments are three-fold: First, that the drug is far safer than a traditional surgical procedure, given its lower rate of complications. Second, that although the cost of RU-486 is comparable to the cost of a surgical abortion, the nation's largest insurance companies (including Aetna, Inc. and Cigna Corporation), have announced their intention to incorporate the pill as part of their standard coverage. Most significantly, these staunch supporters believe that RU-486 will help to erase the moral stigma associated with abortion in today's society. The pill privatizes the procedure by taking the intense focus of the debate off the highly-visible abortion clinics and dispersing it among hundreds of thousands of medical offices across the country. It grants both the doctors who choose to prescribe the pill and their patients a greater degree of anonymity.

It's a line of reasoning that makes a great deal of sense; and yet, there is a faction of the pro-choice movement--including myself--for whom such arguments ring somewhat false. It's a contradiction of sorts: I believe in a woman's right to choose, and therefore I support RU-486 for its ability to make that decision a safer and more accessible choice. But I'm not at all comfortable with the third point, this rhetoric that the pill is a panacea of sorts. The idea of making the abortions more morally morally because they have become somewhat less medically dangerous is nothing short of disturbing.

According to a Kaiser Family Foundation survey taken this summer, one in three gynecologists who will not currently perform abortions stated that they would definitely prescribe RU-486 once it became available. This seems to me an incongruous position to take. This one-third, who in most cases could with relative ease take the time to become certified to perform surgical abortions, have consciously chosen not to do so. And yet these same physicians are more than willing to prescribe a drug that produces the same effect--why?

It seems to me they are taking the easy way out. These doctors, like so many others, seem more willing to accept abortion in pill form because it is less controversial and requires less positive consent than surgical abortion. The doctor neither physically performs an abortion nor is labeled an abortionist--he or she is afforded a sort of distance from the event that allows them not to have to think as deeply about the consequences of their actions.

This kind of attitude will hardly advance the pro-choice cause by removing the stigma of shame from having an abortion; it will merely hide the same old prejudices behind closed doors. If pro-choice advocates really want to make a difference in the national attitude about abortion, they will need to do much more than extol the virtues of a "wonder" drug. They will have to continue to present their arguments as to why having or performing an abortion is a morally acceptable decision to make.

Alixandra E. Smith '02 is a government concentrator in Kirkland House. Her column appears on alternate Thursdays.