Experts Foresee No RU-486 Revolution
For years, abortion advocates have hailed RU-486 as a drug that would radically alter the reproductive landscape in the United States, taking the decision to terminate a pregnancy out of clinics--which have become targets for protest--and into the privacy of the doctor’s office.
But now that the FDA has approved the pill, a central question remains unanswered: How likely will doctors be to prescribe it?
While one study suggests that doctors who do not perform surgical abortions will be more likely to perform so-called medical abortions using RU-486, experts predicted that the medical community will be cautious in accepting RU-486 and that the drastic changes envisioned by advocates will take years to achieve.
“This is a welcome new addition, and it is long overdue in my estimation,” said Dr. David Grimes, head of the Department of Obstetrics and Gynecology at UC San Francisco and one of the nation’s top experts on RU-486. “But it is not going to revolutionize the practice of abortion in America. It’s going to be another option for women who choose it.”
There are a variety of reasons for this: Medical abortions are different but no less complicated than surgical abortions. There are side effects of cramping, vomiting and nausea. Women who take RU-486 must make three visits to the doctor, and doctors who do not perform surgical abortions must be prepared to refer patients with complications to clinics or to other doctors who perform surgical abortions.
Moreover, the drug is approved only for women in the first seven weeks of pregnancy. In the United States, roughly half of all abortions take place later than that. If experience in France is any guide, only a minority of women will choose RU-486. In that country, where medical abortions have been offered for a decade, only 20% of women seeking abortions use that method.
“This drug imposes some rather inconvenient burdens on patients,” said Dr. Ezra Davidson of Los Angeles, who chaired the Food and Drug Administration advisory panel that recommended approval of the drug in July. “Some women will probably elect to have a traditional surgical abortion to just get it over with in one sitting.”
*
The real promise of RU-486, Davidson added, is that its approval opens the door for research into other drugs that may have fewer side effects. It will be those drugs, he predicted, that will really change abortion practice.
Proponents of RU-486 have long hoped that the drug would make abortion more accessible to women who now have difficulty finding abortion providers. The dearth of services in rural areas is particularly acute. There is one abortion provider in all of South Dakota and just one in North Dakota. But whether RU-486 will fill that gap remains to be seen.
