Can RU-486 Be Tailored for U.S. Women’s Use?
After years of controversy and anticipation, the U.S. Food and Drug Administration is poised to approve the drug mifepristone (RU-486) for abortion, but questions remain regarding how this method will be used, says a prominent researcher.
“RU-486 is the first truly innovative approach to fertility control in a generation. Everything up until now has been a variation on an existing theme,” said Dr. David Grimes, vice chair of obstetrics-gynecology and reproductive sciences at UC San Francisco.
“The issue that remains unresolved is how best to implement this approach in the U.S. health care system,” added Grimes, speaking at the American Medical Assn. meeting for science writers here Monday.
About one-quarter of U.S. pregnancies end in abortion, and experts estimate that as many as 20% of abortion patients will opt for the method. Its advantages include more privacy for the woman since she wouldn’t have to seek care at an abortion clinic, the ability to use the medication very early in the pregnancy and the decreased risk of infection compared with surgical abortion. The drawbacks to RU-486 are that the process takes longer, there is a slight risk of hemorrhage and it doesn’t always work, leaving the patient in need of a surgical abortion.
RU-486, or medical abortions, require a two-step process. The first medication, mifepristone, blocks the action of progesterone, the hormone required to sustain pregnancy. Several days later, the drug misoprostol is administered. This drug causes uterine contractions to begin and a miscarriage to occur. At least one more visit may be required to make sure that the pregnancy is terminated.
“Follow-up becomes really critical,” Grimes noted. For example, in France an abortion with RU-486 typically requires three to four doctor’s office visits. But that might not work for Americans.
“For women in rural areas, access [to health care providers] is a problem. What we really need to know is, ‘Can a woman take this at home?’ ” Grimes said.
A high number of women--up to 10% in some states--live in counties with no family planning clinics. And it’s not clear just how enthusiastic private doctors will be about providing medical abortions. Grimes, however, believes plenty of doctors will eventually respond to the need.
“There is widespread enthusiasm by American women and physicians for this method,” he said. “It’s safe for abortion and as an emergency contraceptive. What it does is produce a miscarriage. So the infrastructure is already there to deal with that.”
