The Rebel Girl: RU-486, Some Hard Questions

— Catherine Sameh

RU-486, COMMONLY KNOWN as the French abortion pill, is now in the hands of a few select U.S. physicians. Over the next few months, protocols will be established to administer the drug to patients under a controlled study.

The pending widespread availability Of RU-486 in this country, though potentially exciting, raises many hard questions for reproductive rights activists and health care workers.

First, it is crucial that a common misconception about the "privacy" of RU-486 be corrected. Under the French protocol, women make a total of four visits to their physicians. The first visit is to confirm pregnancy of five to seven weeks, the second to receive the RU-486, the third to take a prostaglandin booster and the fourth to confirm complete miscarriage. At the third visit, two days after the RU-486 is taken, women are monitored for four hours to make sure they miscarry without significant problems.

The U.S. protocol most likely will not require four visits, but the important point is that women will need to spend some time at climes or physicians' offices with direct medical supervision. With surgical first trimester abortions, most women make one visit of two to three hours to a clinic or doctor's office, and most often don't need a preliminary or follow-up visit.

Possibly, at some point down the road after initial studies are completed, women will need minimal or no medical supervision with RU-486; but for now, abortion with RU-486 is more complicated than a routine early surgical abortion.

Second, it is important to breakdown the false dichotomy between surgical abortion as "Invasive" and RU-486 as "noninvasive." it is true that surgical abortion requires the entry of instruments into the uterus, but compared to other surgical procedures; both the number of instruments and the amount of time they are used is remarkably small.

In my estimation, the tendency to think of surgical abortion as "invasive" springs more from the propagation of wild myths by the anti-abortion movement about the danger of abortion, combined with the legitimate feelings of vulnerability female patients have in a sexist health care system, than from the reality of the procedure itself.

But is ingesting a high level of synthetic hormones over a short period of time "noninvasive“? In the context of a health care system that has spent exorbitant amounts developing and uncritically promoting hormones for women, and that virtually has shunned questions about their safety until women developed serious problems or terminal diseases, concerns about long-term side effects of RU-486 are hardly paranoid.

No Substitute for Access

Finally, it is worth asking why RU-486 is being heralded as an alternative to surgical abortion, rather than as another option to ending an early pregnancy. The answer is obvious to those who have been tracking the steady erosion of access to abortion, through restrictive state laws and through anti-abortion harassment and violence. For abortion providers and their allies in the pro-choice movement, the fear of abortion becoming completely inaccessible for most women, if not illegal, is all too real.

But given the depth and complicated nature of this crisis, pinning our hopes on RU-486 as a cure-all is not only naive but mistaken. The legalization of abortions, and the creation of feminist health care facilities willing and able to provide them, came out of an historic struggle by women to gain control over their lives.

On some level, portraying RU-486 as an easier or superior alternative to surgical abortion gives legitimacy to the anti-choice movement by reinforcing the notion that surgical abortions are difficult, dangerous and undesirable, and thus profoundly undermines the gains of the women's movement.

I realize how difficult it is to raise concerns about RU-486 when the anti-choice movement is foaming-at-the-mouth, dead set against it. I fully believe it should be available to all women as a means of terminating early pregnancy.

But aside from the concerns raised above, questions remain about the cost of RU-486, about whether Medicaid will pay for it, and ultimately about who really will have access to it Supporting RU486 uncritically and inflating its potential encourages a tendency to look for simple, more individualized solutions and draws attention away from some of the harder, though more longterm, solutions to abortion access.

July-August 1993, ATC 45

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