The Stark Reality of U-486

After a two day whirl of inaugural balls and congratulatory parties, it was time for President Bill Clinton to get to work. Arriving in the Oval Office on January 22, 1993—the anniversary of Roe v. Wade—he abolished a series of pro-life government policies in a flurry of presidential memoranda.

The longstanding “Mexico City Policy” was rescinded, allowing federal money to be paid to Agency for International Development subcontractors who promote and peril form abortions in developing nations. The moratorium banning the use of federal money for transplantation research on fetal tissue obtained from induced abortions was rescinded. The ban against privately funded abortions at military hospitals was rescinded. The “gag rule” prohibiting abortion counseling at federal Title X family planning clinics was rescinded. Finally, the government ban on the importation of the abortion pill RU-486 was to be reviewed, and if possible, rescinded “immediately.” The president further directed the Department of Health and Human Services (HHS) to “promote the testing, licensing, and manufacturing” of RU-486 in these United States.

“Today,” said the new president, “marks the beginning of a new national health policy that aims to prevent unintended pregnancies.”

In fact, not one of the president’s memoranda dealt with preventing pregnancy: They all dealt with ending pregnancy. These new policies were designed instead to prevent unintended birth.

While the first four policies went into effect immediately, lifting the ban on RU-486 would take time; but clearly, the review would be perfunctory.

Abortion advocates had long sought the importation of RU-486, citing the decline in the number of abortion clinics and providers. “Eighty percent of counties in this country do not have an abortion provider, so access is very limited and . . . concentrated . . . in major metropolitan areas” said Tamara Morris, Planned Parenthood’s vice president for marketing in November 1996. Over the years, more and more doctors had opted out of the abortion business, citing personal qualms or social stigma. Yet studies found that doctors were more inclined to provide abortion services if it could be done quietly, as with RU-486. The pill allowed abortions to be performed in the privacy of a doctor’s office, or even in one’s home. A senior Clinton administration official admitted in 1996 that making RU-486 available was as much about transforming the polarized politics of abortion as it was about making abortion services more readily accessible.

“There will be many more outlets for women, and the protesters are not going to know who to target,” said Morris.

For others, RU-486 was appealing because it allowed a woman to avoid surgery, and the use of the pill was thought to be more “natural.” RU-486 “is not that complicated and it’s not much more than if you had a normal miscarriage, where you would get cramping and bleeding [sic],” said Population Council spokeswoman Sandra ‘Waldman. “They can have their loved ones around them,” remarked Morris of Planned Parenthood.

So the sales pitch was this: Take control of your life and your body. Have a “natural” abortion that is “not much more” painful than your average miscarriage, and abort the fetus in the comfort of your own home, disposing of it in your own toilet—all with your husband, lover, and/or kids nearby. It sounded so easy.

To ease the process of promoting RU-486, HHS turned to the Population Council, a nonprofit organization involved in contraceptive research and abortion/family planning advocacy around the globe. After “complex negotiations” spearheaded by HHS, the developer and manufacturer of RU-486, French pharmaceutical company Roussel Uclaf, agreed to “donat[e], without remuneration” the patent rights for RU-486 to the Population Council. In turn, the council agreed to “take the necessary steps to bring RU-486 to the American market.”

However, despite the promotion of the Clinton administration, RU-486 was still banned in the U. S., and needed FDA approval. This meant a lengthy period of clinical trials, data collection, analysis, and approval hearings.

Hailing the ascent of a new “abortion revolution,” abortion advocates began the clinical trials of RU-486 in Planned Parenthood clinics around the country.

But as with many things in life, reality does not always match the sales brochures. Eighty-two percent of patients reported painful contractions, and as many as 30% defined their symptoms as severe. Side effects included headaches, dizziness, heart palpitations, and nausea.

Vacuum or surgical abortions are comparatively less violent. When women arrive at an abortion clinic they know they are pregnant, but for many this means little more than “the urine stick turned blue.” While their bodies are providing a nurturing environment for the fertilized egg, their awareness of these radical internal changes is still minimal. They know they are pregnant, they just don’t “feel” pregnant; the changes in their bodies haven’t yet registered their imprint on the conscious mind. At the abortion clinic, the woman walks in pregnant, goes to sleep, and is not pregnant when she wakes up. It’s all very dreamy and unreal, and it’s all over in one day.

In contrast, an RU-486 abortion is an “up close and personal” experience. It requires more visits and a greater commitment to the full process. In a surgical abortion you have to face the hard realities of your choice for only one day. An RU-486 abortion forces a woman to carry the awareness of her choice with her day after day until the actual abortion occurs.

The first visit consists of a physical exam, which includes a blood test, a urine test, and, most importantly, an ultrasound to determine the age of the fetus and ensure that the pregnancy is not ectopic. The woman is then given RU-486, an antiprogestin. The hormone progesterone helps fertilized eggs to implant and develop in the uterus. Blocking the hormone causes the embryo’s bond with the uterus to break down, starving the fetus of vital nutrients.

At the second visit, usually two days later, the patient is given a drug that forces the uterus to contract and expel the fetal sac. The Population Council says 54% of patients abort within four hours; 75% within twenty-four hours.

Five to ten percent never abort at all, so a third visit, twelve days later, is needed to confirm the completion of the abortion process by either ultrasound or blood test. (Fearing incomplete abortions and possible birth defects, doctors require all RU-486 candidates to sign a general release before using the pill.) If, after two weeks, the pregnancy isn’t aborted, the women are committed to a surgical abortion.

The second visit is the most traumatic. The pain of the contracting uterus focuses the woman’s attention on what is happening to her body, as she lies there waiting for the abortion to occur. The mother feels the passing of the fetal sac, and has to dispose of it herself. She faces in the most brutal fashion the result of her choice. This, by far, is the most painful part of the RU-486 abortion.

Anecdotal reports of those who have had RU-486 abortions highlight the emotional impact of the abortion pill.

“Oh, it hurts,” said a thirty year old mother of three. As Newsweek reported in 1995, “The pain stops abruptly and [she] relaxes, her face glistening with sweat.” Minutes later she calls her husband into the bathroom to view the fist-sized fetal sac at the bottom of the toilet. “[She] can see the curled-up fetus, the size and color of cocktail shrimp . . . Its hands are curled into tiny fists.”

“It’s sad. It’s sad.” She quietly turns away.

Another young woman followed by Newsweek waits nine days before the fetus is expelled while she is taking a shower. Too big to be washed down the drain, she “scoops it up, wraps it carefully in toilet paper” and flushes it down the toilet.

In France, a young American who used the abortion pill said of her fetus: “[I]t had two dark spots like eyes and a little skeleton not quite formed.” During clinical trials in France, a nurse recounted seeing six embryos in surgical dishes lined up near the sink. “It was upsetting,” she said. “It was like looking at a row of people.” Oddly enough, despite her description she remained committed to abortion.

These reports are revealing. There seems to be a primal sadness, a recognition of the shattered bond between the woman and the tiny amorphous sac—a recognition that surgical abortion precludes. For many women, this chance to “say goodbye,” they claim, helps in the healing process. For others, it is a wakeup call. None take it lightly.

A Swedish study conducted in 1992 confirmed that not only were the pain and bleeding greater in an RU-486 abortion as compared with a surgical abortion, but that women reported more “moral considerations” when confronted with the stark realities of the abortion pill.

The emotional trauma associated with seeing and disposing of one’s own fetus has affected the abortion landscape. During clinical trials in the United States, the Population Council followed the example of Britain and Sweden, which allow the abortion pill to be used up to sixty-three days into the pregnancy. In the end, however, they chose to follow the French, who, in 1994, decided not to allow RU-486 abortions in the eighth and ninth week. The Population Council told the FDA it plans to market RU-486 for use before the seventh week of pregnancy.

Some of the reasoning behind the smaller window of usage lies in the fact that RU-486 abortions are more difficult in the later weeks. But there are other, more political dynamics at work as well: In this crucial two week window, the fetus, no longer just an embryonic sac, begins to look very much like a baby with easily identifiable and familiar body parts. Viewing and disposing of a fetus with distinct human features makes the reality of abortion painfully clear. The woman understands more intimately, more clearly, that she bears responsibility for the life that was once in her womb.

The psychological effects of an RU-486 abortion may affect the abortion debate in ways yet unknown. What is known is that in an RU-486 abortion, no one, neither mother nor child, walks away unscathed.

Author

  • Marianne Garrabrant

    At the time this article was published, Marianne Garrabrant was a freelance researcher and writer from New Hampshire.

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