Long-Awaited Abortion Pill Will Offer More Privacy--But No Less Controversy
For women who decide to seek an abortion, mifepristone has some clear advantages. Surgical abortions, in which the uterus is emptied by suction or other means, often cannot be done until several weeks after a woman learns she is pregnant. Mifepristone, by contrast, is more effective the earlier in pregnancy it is used.
The drug works by blocking the action of the naturally occurring hormone progesterone, which is crucial in the earliest stages of pregnancy, helping to build the lining of the uterus to support the fertilized egg. When it is blocked, the lining breaks down, and bleeding often begins. Misoprostol, which is an approved ulcer medicine, is given two days after the mifepristone. Misoprostol causes the uterus to contract and expel the fertilized egg. In women who have been pregnant for 49 days or less, the regimen works 92 percent of the time. When it fails or causes excessive bleeding, doctors perform a surgical abortion.
Learning curve. An estimated 500,000 women in Europe have taken mifepristone, as have thousands more in clinical trials in the United States. Its safety record is generally good, doctors say, although it should not be used in peo- ple taking corticosteroids, often given for asthma, or blood-thinning drugs.
Doctors say that patients should be counseled and monitored carefully, because the cramps and bleeding can be alarming. "If you do the counseling right, the phone doesn't ring," says Richard Hausknecht, associate clinical professor of obstetrics and gynecology at Mount Sinai School of Medicine, who has provided over 3,000 medical abortions during clinical trials of mifepristone and in an off-label use of a cancer drug called methotrexate. "But if you don't do the counseling right, you will not sleep."
Doctors need to learn how much bleeding and pain is acceptable, so that they don't intervene too early with a surgical abortion. "There is no question the learning curve is steep with this drug," says Hausknecht. As a result, says Caroline Westoff, medical director of family planning at Columbia University, doctors who do not perform abortions now may be slow to offer mifepristone. "This is not going to be like a new diet drug," she says.
Nor will medical abortion be any less expensive than an early-term surgical procedure, which typically runs between $350 and $500. Between a third and half of workers with health insurance are covered for abortion, according to a recent survey conducted by the Kaiser Family Foundation, and their plans are expected to cover mifepristone, too. Under federal law, Medicaid covers abortion only when the pregnancy results from rape or incest or endangers the life of the mother, although some states have expanded Medicaid coverage.
Other barriers facing women who seek an abortion will not disappear with the approval of the drug. Troy Newman, director of Operation Rescue West, an anti-abortion group in Los Angeles, says the organization plans to picket places where the drug is available. "We will treat medical abortion no differently than any other method," he says. "We will be picketing and protesting at any abortion clinic or provider, even if it is a pharmacy." And state laws mandating waiting periods or parental notification or consent for abortion will apply to the new drug as well. "This is not going to be a cosmic revolution," says Michael Burnhill, vice president of medical affairs for Planned Parenthood. "What it is, is an advance."
WHERE TO LEARN MORE Getting it. The National Abortion Federation hotline, 800-772-9100, will provide referrals to physicians and clinics offering mifepristone once approved.
Medical details. The Population Council Web site, www.popcouncil.org, describes mifepristone safety, use, and trials. Follow links through "Reproductive Health and Family Planning."
The morning after. The hotline at 888-NOT-2-LATE gives referrals to local health care providers willing to prescribe emergency contraception.
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