RU-486 - myth #2 - private way to end a pregnancy

(Excerpt from Renate Klein's book RU486: Misconceptions, Myths and Morals)

Privacy versus Control

"Many of the claims about RU 486 are based on its supposed privatization of the abortion experience. Ellen Goodman, for example, in her syndicated column, calls for the marketing of RU 486 in the United States. `What could be more private than taking a pill? How could a state control swallowing?' (1989: 11). Like Goodman, the media presentation of the new abortion pill in western countries tends to simplify and idealize the drug. The going wisdom holds that a woman pops a pill in the privacy of her own home and the pregnancy disappears.

The medical literature tells another story, belying the myth of the do-it-yourself abortion, Yet here too, the rhetoric of more control for women over the abortion experience exists with an entirely different reality. At a European meeting of gynecologists and obstetricians in 1987, Etienne Baulieu proclaimed that 'RU 486 could be a prototype of the second generation of ways of giving women more control of their fertility' (Baulieu, 1988b: 128). But in the medical journal article, on the same page, and in the same paragraph, he also said `... it should be given under strict medical supervision in specialized centers' (idem.). So what are women to make of these conflicting claims and is effective doublespeak?

The clearest answer lies in the medical journal article themselves. The conclusions that much of the medical literature draws are not consistent with the findings that the articles present. Additionally, every article, without exception, remarks that RU 486 should be administered only under strict medical supervision. The reality of medical surveillance is not simply physician oversight from a distance but a highly medicalized, multi-step, time-consuming procedure which, for many women, involves continuous suffering and pain. This treatment regimen deserves careful scrutiny.

1. A woman seeking a chemical abortion must submit to physical examination and pregnancy test. This includes a pelvic examination to see if there is any uterine bleeding or previous pelvic infection. During the physical examination, women should be checked for contraindications, making the drug more dangerous for certain women. Most centers, now testing or administering the new abortion pill, use vaginal ultrasonograph i.e. sound waves that project a picture of the embryo a a screen to estimate gestational age of the pregnancy and/or a determination of serum human chorioni gonadotropin (B-hCG) to confirm and define the age a woman's pregnancy.

2. Depending on the legal situation in a particular country, many centers impose awaiting period of at least 24 hours or more after which a woman must return to the clinic hospital for RU 486, given in tablet form (usually three). Contrary to the popular picture of the pill-popping abortion, a woman does not take these tablets home but usually swallows them in the presence of a nurse or doctor while she is at the clinic. This has been one of the myths supporting the privatization argument for RU 486. Some feminists have claimed that women eventually will be able to obtain RU 486/PG at the local supermarket. However a woman must go to a clinic or other medical center to obtain the tablets and return to the center for several visits. During the 48 hours between RU 486 and PG administration, women are required not to smoke or drink alcohol.

3. Procedures at this point vary. Some centers that give RU 486 alone require the woman to visit the clinic seven days after RU 486 administration to confirm that the embryo has been expelled completely. Most centers, however, now administer prostaglandins in concert with RU 486 to hasten and strengthen the contractions that will ultimately propel the embryo from the uterus. Thus women once again must return to the clinic for a prostaglandin injection, vaginal prostaglandin suppositories, or, more recently, oral prostaglandins. The prostaglandins are usually given 36-48 hours after RU 486 administration because it takes this time to fully sensitize the myometrium (part of the uterine lining) to contract (see Chapter Four for an alternative theory).

4. Then the wait begins. Many clinics keep women prone for three to four hours, in the hope that the embryo will be expelled before sending them home. Other women wait longer hours, days, and some even weeks. The only thing private about RU 486 is that the final stage of the abortion, the expulsion of the embryo, often happens at home — or someplace else. To call this an at-home abortion is deceptive, to say the least, since most of the treatment transpires in the clinic or hospital and is extremely medicalized. What actually happens at home can be an excruciatingly long wait for the embryo to be expelled from the uterus, accompanied by pain: bleeding, vomiting, nausea, and other complications that are drawn out over a substantially lengthy period of time compared with a conventional abortion.

5. Finally, a woman must return several days later for physician's examination to make sure abortion complete. (Some studies mention as many as three follow-up appointments, e.g. Hill et al., 1990a: 415). Again, vaginal ultrasound and/or a determination of B-hGG used to ascertain whether the pregnancy has be en terminated and whether the embryonic tissue has been totally expelled. At this point the woman receives another pelvic examination, the third within a time period usually eight days. The pelvic examination, vaginal ultrasound, and other instruments used internally in chemical abortion are important to emphasize, because women have been led to believe that an RU 486/P abortion is free of medical instruments inserted into the body. This misrepresentation singles out only suction curettage as an invasive internal or instrument procedure. In actual fact, chemical abortion involves the use of more interventionist instrumentation than conventional abortion.

6. If abortion is not complete, then a conventional is performed. Between two and 13.4 per cent of undergoing RU 486/PG terminations endure abortion jeopardy (Gao et al., 1988).

How does the claim that RU 486 is a private means of abortion square with the claim that it needs close medical supervision? It doesn't. Physicians have been very explicit that RU 486 will never be available over the counter for do-it-yourself abortions..."

(Pages 25-28 excerpt of Renate Klein's book RU486: Misconceptions, Myths and Morals)