The Unhappy Birthday of RU-486 Approval

by Susan E. Wills

September 28, 2001

An annual feature of Washington life is a celebrity-studded gala greeting the anniversary of Roe v. Wade. With no apparent sense of irony (or taste), they mark another year's toll of death and sorrow with champagne toasts in a downtown ballroom.

September 28 makes another such event-- the first anniversary of FDA approval of RU-486, after a 12-year battle to get it legalized. This is a very big deal to abortion advocates. Planned Parenthood's Alexander Sanger called the earlier (provisional) approval of RU-486 "one of the most important victories for women in this century." Kate Michelman mused that it was the "biggest thing since the birth control pill." RU-486 was "supposed to revolutionize the practice and politics of abortion" (L. Szabo, The [Norfolk] Virginian-Pilot], 9/24/01).

So why all the glum faces at Abortion, Inc.? What happened to all their bright dreams – of "mainstreaming abortion" throughout the medical community, bringing abortion services to every "unserved" county, village and block in the U.S., ending clinic protests, and making a "killing" financially from this miracle drug?

A Kaiser Family Foundation survey of gynecologists and general practice doctors released this week shows that neither patients nor doctors share the abortion lobby's enthusiasm for RU-486. Most doctors don't want to offer it. And most abortion clients, when it is offered to them, don't want to take it. Only 1% of GPs offer RU-486 to patients. Only 6% of gynecologists surveyed (12% of the gynecologists who perform surgical abortions) provide this option. These figures compare to 44% of gynecologists who, before FDA approval, told Kaiser they'd be interested in providing the drug if it were approved. So much for mainstreaming.

Why hasn't RU-486 caught on? According to the Kaiser survey, doctors give many reasons. Forty percent of gynecologists and 37% of GPs refuse because they "personally oppose" the use of RU-486. The rest, i.e., those who did not express personal opposition, cite lack of patient demand, concerns about protests or violence, no interest in performing abortions, inadequate office space, and "too much political controversy" surrounding abortion.

Doctors interviewed for recent stories in the press add a few other reasons. "The more familiar doctors became with the drug's financial, procedural, and political hurdles, the less enamored they were of it" (R. Padawer, The [Bergen County] Record, 9/25/01). Economics definitely figures into it. One doesn't specialize in abortion for the sheer joy of it. It's all about money. And Population Council (PC), the drug's distributor, put a hefty price tag on the two-pill regimen: $270. Add in the "physician fee," counseling, three patient visits, and the cost of ultrasound–for doctors who comply with the FDA mandate to rule out ectopic pregnancy and pinpoint gestational age–they have to charge almost twice the cost of a surgical abortion to make ANY profit.

Women are not clamoring for RU-486 either. A clinic administrator in Virginia notes that "many women are disappointed when they hear that taking 'the abortion pill' is nothing like swallowing an aspirin. 'It's not like pop a pill and – poof! – you're not pregnant'") (Szabo). I wonder who led them to believe it was that easy?

Many women prefer surgical abortion to "get it over with" as soon as possible, can't afford the higher fee or can't arrange for three office visits. "Other women are uncomfortable with the uncertainty of a medical abortion. Doctors simply have no way of knowing how severe the process will be" (Szabo).

One solution for the high price–adopted by most Planned Parenthood clinics–is to flout FDA regulations and give women a 200-mg dose of mifepristone, rather than the 600-mg dose called for. "But many physicians are uncomfortable deviating from FDA protocol" (Padawer).

Due to the underwhelming response, the National Abortion Federation was forced to undertake a "massive promotional campaign for the drug, using the new 'early option pill' name" (B. Basinger, Jacksonville Times-Union, 9/23/01). Ads will appear in 14 national magazines, cutting even further into their profits.

If that weren't enough to dampen anniversary spirits, in the last month two press reports brought more bad news. The September 1 issue of New Scientist reports on "a minor epidemic of birth defects in developing countries" where poor women take misoprostol (the second drug of the RU-486 regimen) to induce an abortion. Alone, misoprostol is effective only 40% of the time. "Doctors have discovered a high rate of birth defects among infants exposed in utero to misoprostol, such as fused joints, growth retardation and a paralysis of the face called Moebius syndrome" (Agence France Presse, 8/29/01).

The worst news came from Canada, however: the death of a woman participating in Population Council's Canadian trials. PC assures us that the cause of death, clostridial sepsis, is rare and may not have been related to the RU-486 trial. In fact, this is a life-threatening infection which can result from an incomplete abortion. It's the kind that kills women after incomplete surgical abortions–whether legal "botched" abortions or illegal "back alley" abortions. The Canadian trial was suspended.

Time for a second look, FDA?

Susan Wills is associate director for education, USCCB Secretariat for Pro-Life Activities.