Pill of Choice

Pill of Choice


It took twelve years for the FDA to approve mifepristone–also known as RU-486–and most of that time had less to do with medicine than with the politics of abortion. Still, the late-September decision was a tremendous victory for American women. In approving RU-486, the FDA showed that science and good sense can still carry the day, even in an election year.

The long delay may even backfire against the drug’s opponents. In 1988, when mifepristone was legalized in France, it was a medical novelty as well as a political flashpoint. Today, it’s been accepted in thirteen countries, including most of Western Europe; it’s been taken by more than a half-million women and studied, it sometimes seems, by almost as many researchers. By the end of the approval process, the important medical professional organizations–the AMA, the American Medical Women’s Association, the American College of Obstetricians and Gynecologists–had given mifepristone their blessing; impressive percentages of Ob-Gyns and family practitioners said they would consider prescribing it; thousands of US women had taken it in clinical trials and given it high marks, with 97 percent in one study saying they would recommend it to a friend. Against this background of information and experience, the antichoicers’ attempt to raise fears about the drug’s safety sounds desperate and insincere.

In a normal country, RU-486 would simply be another abortion method, its use a matter of personal preference (in France it’s the choice of 20 percent of women who have abortions, while in Britain only 6 percent opt for it). But in the United States, where abortion clinics are besieged by fanatics and providers wear bulletproof vests, mifepristone’s main significance lies in its potential to widen access to abortion, especially in those 86 percent of US counties that possess no abortion clinic, by making it private–doctors unable or unwilling to perform surgical abortions could prescribe it, and women could take it at home.

It is unlikely, however, that Mifeprex, as the drug will be known when it comes on the market, will prove to be the magic bullet that ends the war on abortion by depriving antichoice activists of identifiable targets. The nation has been retreating from Roe v. Wade for a quarter-century, and a good portion of the patchwork of state and local regulations intended to discourage surgical abortion will apply to Mifeprex as well: parental notification and consent laws (thirty-two states), waiting periods (nineteen states), biased counseling and cumbersome reporting and zoning requirements. States in which antichoicers control the legislatures will surely rush to encumber Mifeprex with hassles, and small-town and rural physicians in particular may find it hard to prescribe Mifeprex without alerting antichoice activists. Doctors are a cautious bunch, and the anticipated flood of new providers may turn out to be a trickle, at least at first. Abortion rights activists should also brace themselves for a backlash from their hard-core foes: Just after the FDA’s decision was announced, a Catholic priest crashed his car into an Illinois abortion clinic and hacked at the building with an ax.

But in the long run, Mifeprex will make abortion more acceptable. In poll after poll Americans have said that when it comes to terminating a pregnancy, the earlier the better. Mifeprex, which has been approved for the first forty-nine days after a woman’s last menstrual period–when the embryo’s size varies from a pencil point to a grain of rice–may well prove not to arouse the same kinds of anxieties and moral qualms as surgical abortion. Then, too, Americans are used to taking pills. That, of course, is what the antichoicers are afraid of.

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