On October 17, almost one month after the United States Food and Drug Administration (F.D.A.) approved mifepristone, a new study shows that the F.D.A.’s prescribed regimen for the drug could be simplified to lower costs, ensuring that more women would have access to the non-surgical abortion. The study involed 2,295 women in 16 primary care centers and abortion clinics bwetween March 1998 and June 1999. It was funded in part by the advocacy group Abortion Rights Mobilization.
Mifepristone, a.k.a. RU 486, has been available in France since 1998. In Europe alone, more than 620,000 women have successfully used the drug. In the U.S., antiabortion politics led to an F.D.A. import ban on the drug in 1989, delaying its approval for 12 years. But in September, U.S. decision-makers made the choice to acknowledge science over politics and give women their due.
The catch is now in the cost. The procedure mandated by the F.D.A. for administering the 200 mg pill—manufactured under the brand name of Mifeprex—is an estimated $300, which is the average price of a surgical abortion. “The reason is that it requires an immense amount of counseling, and that’s an expensive proposition,” says Gloria Feldt, President of Planned Parenthood Federation of America. The “pill,” which is actually a series of pills, can be administered in standard medical offices and clinics over a two-week period.
After signing several consent forms, the FDA-approved procedure for the drug involves three office visits. On the first visit, a patient receives three doses of 200 milligram tablets of mifepristone, which blocks the production of the progesterone that is needed to sustain a pregnancy. Two days later, the F.D.A. mandates a return visit to the doctor for a dosage of two 200 milligram tablets of misoprostol, which causes the uterus to contract and expel the aborted fetus. A follow-up visit approximately 12 days later is required to verify that the pregnancy has been terminated.
Some people feel, however, that the second office visit may be unnecessary because, according to the study released in October, misoprostol can be safely and effectively self-administered at home one to three days later. Eliminating this visit would not only reduce the cost of administering the drug, but would save the woman a burdensome trip to the doctor as well. The study also found that mifepristone can be safely administered to a woman who is eight weeks pregnant. The F.D.A. has only approved use of mifepristone for women up to their seventh week of pregnancy.
Still, for those feminist activists who have been fighting for the F.D.A.’s approval of mifepristone for two long decades, one cannot help but hear cheers of “FINALLY” from the mouths of the women’s movement, despite the regulations surrounding the drug. “This early option pill for termination of pregnancy without surgery has gone through not only the arduous scientific process that every new drug should go through but also the most arduous political process that any drug has ever gone through. It should never have taken this long to reach American women,” says Planned Parenthood’s Gloria Feldt. Adds Eleanor Smeal, president of the Feminist Majority Foundation: “Women all over will now seek approval. Everything was waiting for America. Now that we have moved ahead, Canada will follow and, I think, much of the developing world.”
But the politics behind the approval of mifepristone in the U.S. aren’t over yet. Pill-induced abortion still remains on shaky ground because of the power of states to restrict it. “Doctors can prescribe it. It’ll be legal and fine for them to do that. A state can say, however, that there are restrictions on minors or anyone using it,” says Karen Raschke, Director of State Programs for the Center for Reproductive Law and Policy.
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