COLUMN ONE : A French Option on Abortion : RU-486 ends pregnancy without surgery, but concern over political debates, lawsuits and other issues have kept it from the U.S. and other nations.

Annie, a 29-year-old secretary in an import-export business, already had two young children from a marriage that ended in divorce.

“If I have another child, I want it to be with someone I have truly chosen,” she said resolutely. “It’s the mother who takes charge of the children.”

Chantal, 23, a dressmaker from the French Caribbean island of Martinique, said she did not know her boyfriend well enough to have his baby.

“He left on vacation and promised to write,” she complained, “but so far I haven’t heard a word from him. I don’t want to find myself with the kid of a man I hardly know.”

On a sultry August morning, the two women found themselves sitting side by side in reclining chairs at the regional hospital in Villeneuve-St. Georges, a working-class Paris suburb. Both women were seven weeks pregnant. Like more than 50,000 other French women in the past two years, they had chosen to abort their pregnancies chemically, using the French produced abortion pill known as RU-486.

The two women, who asked that their full names not be used, represent an option not available to the women of the United States or most other countries--abortion without surgery.

In less than two years since it was first put on the French market, the abortion pill has been a big success in France.

Although its use is restricted to women in their first seven weeks of pregnancy, nearly 30% of all abortions in France are now brought about by RU-486. The drug works by blocking the hormone progesterone that is essential to maintaining pregnancy. Under the procedure established by the French, three aspirin-sized tablets of RU-486 are given to the women. Two days later, they are injected with prostaglandin, a synthetic hormone that causes the uterus to contract. The combination of the two drugs produces a chemically induced miscarriage in 96% of the cases.

In February, the French Ministry of Health, working closely with the French manufacturer, Roussel-Uclaf, took the important step of approving government reimbursement for women who use the abortion pill method. More than 800 clinics and hospitals in France have been licensed to distribute the product, which is not available in pharmacies. Last month, Roussel-Uclaf announced that it would apply for a permit that could make it available in Britain within 18 months. Several Scandinavian countries are said to be waiting in line as well.

But despite appeals from American scientists and abortion rights advocates, Roussel-Uclaf has so far refused to apply for Food and Drug Administration approval to enter the key U.S. market, where last year more than 1.5 million surgical abortions were performed. In February, the firm discontinued its supply of RU-486 to the Los Angeles County-USC Medical Center Women’s Hospital, until then the only North American site for RU-486 research.

In defense of their position, Roussel-Uclaf officials say they fear that the volatile public debate on abortion and the constant threat of product liability lawsuits in the United States could redound against the French firm’s West German parent company, Hoechst, A.G., which last year had $6.4 billion in sales in North America, primarily in the United States.

“Abortion is a very controversial issue in the United States,” said Ariel Mouttet, director of international marketing for Roussel-Uclaf. “It is like a war. We feel that it is not the job of our company to get involved in this war.”

Meanwhile, American abortion rights advocates and the abortion pill’s enthusiastic inventor, Prof. Etienne-Emile Baulieu, contend that the company is misreading the trends in American politics.

Late last month, a delegation of scientists and feminist leaders organized by a U.S.-based group called the Feminist Majority met with Roussel-Uclaf executives in Paris and presented them with petitions bearing 115,530 signatures urging the introduction of RU-486 in the United States.

Delegation leader Eleanor Smeal said the group reviewed the political debate with the Roussel-Uclaf officials on a state-by-state basis. “We stressed that the opposition to abortion is not really very large,” Smeal said.

Like many international health officials, pill inventor Baulieu, a likely candidate for a Nobel Prize for his discovery, feels that acceptance in the United States is also key to distribution in the overpopulated countries of the Third World, where an estimated 150,000 women die each year because of complications from legal surgical abortions and botched illegal abortions.

“More than 25% of the funding for the World Health Organization comes from the United States,” said Baulieu, interviewed in his cluttered office at the National Institute of Health and Medical Research in a suburb of Paris. “Without U.S. approval, WHO and other organizations are not going to take the risk of employing the pill in the countries that need it most.”

In this respect, said Baulieu, the ongoing American political debate on abortion--which has already figured prominently in several state elections--has ramifications far outside the borders of the United States.

Roussel-Uclaf officials say they are reluctant to enter Third World markets because the strict medical supervision needed to ensure the safety of RU-486 cannot be maintained in primitive settings. Under the French abortion law of 1975, a woman who decides to have an abortion must undergo a “week of reflection” before the abortion is actually performed.

In France, use of RU-486 is supposed to be limited to women who are no more than seven weeks pregnant. The “week of reflection” is followed by a manual and an ultrasound examination before the RU-486 pills are given to the patient. After the injection of prostaglandin two days later, the woman is required to remain in the clinic for three hours before returning home. Two weeks later, she is asked to return to the clinic for another manual and ultrasound examination.

So far, Baulieu and other researchers say, there have been no deaths attributable to the RU-486 treatment. However, telephone interviews with more than a dozen participants in the program showed that the procedure is usually accompanied by intense pain from contractions experienced during the chemically induced miscarriage following the injection of prostaglandin.

Responding to an advertisement placed by The Times in the French daily newspaper Liberation, most of the women said they would choose the method again if they wanted an abortion. The advertisement promised anonymity to callers who would describe their experiences with RU-486.

One woman, Sandrine, 24, who identified herself as a student in international law in Paris, reported that she was permitted to take RU-486 when she was nine weeks pregnant, two weeks beyond the limit set under the standard procedure outlined by Roussel-Uclaf.

“I went to a small private clinic where they didn’t seem to know what they were doing. I had terrible pains,” she said. “Two weeks later I began to hemorrhage and went to the hospital. At the hospital they were astonished to find that they had not given me a curettage at the clinic. (Curettage is the scraping away of the inside of the uterus, usually done as part of an abortion or to clean up after a miscarriage.)

“I do not regret having the abortion,” Sandrine said. “I didn’t want to keep the baby because it was the product of a one-night stand (in French, aventure sans lendemain ). But if I had to do it again, I think I would do it by vacuum aspiration (the most common surgical technique).”

Likewise, Jacquie, 37, a receptionist at a Paris fitness club, said she suffered hours of excruciating pain. “I was very sick for seven hours,” she reported. “I have a 16-year-old girl, and I can tell you the suffering was the same as undergoing childbirth. I continued bleeding for three months after.” Despite all the pain, she said she still considers the RU-486 method the “best form of abortion.”

However, the majority of the women underwent the kind of textbook experience described by Odile, 23, a student teacher.

“I got pregnant after a vacation in Greece, where I had a brief affair and forgot to take the (birth control) pill for three days,” Odile said. “My gynecologist proposed the RU-486 method that she said was 100 times better than the classic abortion. I was only three or four weeks pregnant and didn’t feel anything yet, and I was relieved that I didn’t have to wait. The other advantage is that with the RU-486 you are awake and responsible and not knocked out for the operation. The only traumatic time was the three hours alone in the room with painful cramps. But I had no problem after that. If it happened again, I would not hesitate to use the same method.”

Several of the women said they had abortions using the surgical method before switching to RU-486.

“I had an abortion two years ago in the United States,” said Francoise, 31, a university literature professor. “It was by aspiration without anesthetic in conditions I found very difficult, traumatic and guilt-producing. I found RU-486 more painful but less psychologically damaging. It is a more natural process since it is the body that is acting on its own without traumatic intervention.”

Although France is a predominantly Roman Catholic country where the church has strongly stated objections to both surgical abortions and the use of RU-486, the abortion debate here has not become the important political issue that it has in the United States.

“I think there is a kind of distancing in France from the days of the strong Catholic culture,” said Dr. Bernard Maria, chief of the Obstetrics and Gynecology Department at the Villeneuve-St. Georges Community Hospital, one of the early research centers for the abortion pill. “It has been replaced by a form of Catholic pragmatism. In France, most of the people are Catholic, but most of the women use some form of contraception. We don’t ask anti-abortionists to have abortions. But we would like anti-abortionists to let others who want them have them. To us, this is democracy.”

Baulieu, the pill’s inventor, believes that the difference between the French and American reactions is rooted in attitudes toward government’s role on moral questions.

“In France,” Baulieu said in an interview on French television, “issues of morality tend to be individual, private matters. In the United States, they can turn into general political debates.”

Officials at Roussel-Uclaf, meanwhile, say they prefer to market RU-486 in countries where the governments have shown unambiguous interest in having the pill as an option for women.

Mouttet, the Roussel-Uclaf marketing director, noted that in both France and Britain the government has taken an aggressive stand in favor of offering RU-486 as an alternative to surgical abortion. In the fall of 1988, citing threats from militant American anti-abortion groups, Roussel-Uclaf attempted to withdraw RU-486 from France just a few days after putting it on the market.

However, Minister of Health Claude Evin immediately intervened, threatening to withdraw the Roussel-Uclaf patent for the product.

“I could not permit the abortion debate to deprive women of a product that represents medical progress,” Evin said at the time. “From the moment that government approval for RU-486 was granted, it became the moral property of women, not just the drug company.”

In Britain, Secretary of State for Health Kenneth Clarke defended the pill in Parliament.

In contrast, the debate over abortion in the United States reaches even the First Family, where President Bush and his wife, Barbara, are known to have divergent views, as well as the Supreme Court, where abortion figures to be the key test of new court nominee David H. Souter.

“The United States has to solve the question of how it feels about abortion,” said Mouttet. “We would like to market RU-486 in the U.S., but we feel it is going to be a matter of time before the political debate is settled.”