RU486: Misconceptions, Myths and Morals
By Renate Klein, Janice G. Raymond and Lynette J. Dumble
Spinifex Press, 1991. 151 pp. $14.95
Reviewed by Claudine Holt
RU486, the so-called "abortion pill", is a drug that women can do without. This is the convincing conclusion that Klein, Raymond and Dumble draw after a comprehensive study of the medical trials and literature pertaining to the drug, which has been acclaimed as a miracle for women.
RU486 has been described by drug companies and the international media as a pill that can be swallowed in the privacy of one's home, thereby de-medicalising the abortion procedure. It is claimed to be safe, effective and a superior method to conventional abortion.
What is the real experience of RU486? The authors reveal a more critical picture of the RU486 abortion experience.
Half the book is devoted to the technical aspects of the drug and how it works. RU486 is a steroid and anti-progesterone used in conjunction with prostaglandins (PG). Simply put, RU486 obstructs the formation of the lining of the uterus which supports and nourishes a pregnancy, while the PG encourages uterine contractions which eventually expel the embryo from the womb.
RU486 can be administered by intramuscular injection, suppositories or orally. To prevent complications, the dosage needed to successfully terminate a pregnancy must not be given all at once.
In France, Britain and Northern Ireland, where the drug is licensed and used, strict medical supervision is required. The abortions involve many trips to the doctor over as many as eight days.
First a woman must have a physical examination which includes a pelvic examination for contraindications (conditions or symptoms which may alter the predicted course of the drug) which may exclude her from the procedure, and a vaginal ultrasound to determine the exact age of the pregnancy.
On her second visit she is given the RU486 tablet and allowed to leave but must return for a third visit within 48 hours to take the PG and to have another pelvic examination. Some clinics keep women for three or four hours to wait for the embryo expulsion, but often this can take hours, days, even weeks.
Finally, a woman must return several days later for another examination to make sure the abortion is complete. This involves another pelvic examination (the third) and an ultrasound.
If, after four visits, the abortion is incomplete, a conventional abortion is performed.
The general success rate is said to be 95%, compared with 99% for conventional abortions performed by a competent practitioner.
The success of RU486/PG is diluted when the contraindications and complications that exclude a significant percentage of women from using this method are taken into account.
Age is a contraindication for women under 18 or over 35. Women who are epileptic, diabetic, or suffer from a heart, lung, kidney, liver, stomach, or intestinal disorder are also excluded.
Women who are "overweight" or "heavy" smokers (no definitions given) are also subject to dangers and excluded. If an IUD or hormonal contraceptive has been used three months prior to conception, or if steroid medication has been taken in the previous 12 months, the abortion is not permitted.
For women who are considered suitable patients, the age of their pregnancy needs to be determined because any termination attempted beyond 42-49 days (depending on how the date of conception is calculated) will not succeed using this method. This does not give a woman a lot of time to discover she is pregnant and take steps to have an abortion.
Klein et al argue that the chief problem with the RU486/PG method is the duration and amount of blood loss. The mean duration of bleeding is two weeks, and average blood loss is 70 cc, equal to two average menstrual periods. This compares to blood loss of conventional suction curettage of 10-20 cc. This serious side effect necessitates medical supervision because women may require blood transfusions.
Significant pain that lasts for days, sometimes weeks, is also experienced. Because of the negative interaction of RU486/PG and mild pain-killers such as aspirin, narcotic analgesics are administered instead. In some studies, up to 50% of women required medication to ease the pain.
Other side effects include vomiting, nausea and diarrhoea, making RU486/PG abortion very unpleasant.
Further issues raised in the book include the lack of understanding of PGs and the unknown effects on future pregnancies and fertility.
All of these uncertainties and dangers compare to the record of conventional abortions, which "do not largely involve surgical methods and general anaesthesia; are 99% effective; require two medical visits as opposed to four; have fewer contraindications and fewer and more minimal complications; result in fewer than one percent incomplete abortions and can be performed over a wider range of time".
The authors are concerned that chemical abortion is being posed as a superior alternative to conventional methods. This could accelerate the trend of doctors not learning how to perform abortions.
RU486: Misconceptions, Myths and Morals is an important contribution to a discussion which until recently has been dominated by drug company press releases. While not agreeing with all of the concluding chapter in its hostility to reproductive technologies, I consider this a book of great value to pro-choice/abortion activists.
In Australia, where the drug is not licensed or available, the book clarifies the real issue: the repeal of laws that make it a criminal offence to terminate a pregnancy.
Without repeal, women will never be safe from the threat of life- threatening backyard abortions. And women clearly wouldn't be rescued by a drug that takes several days to be effective, with side effects that linger on.
[Claudine Holt is a member of the Sydney Women's Abortion Action Campaign.]