Mona Charen; Syndicated columnist 10/04/2000
News reports about the FDA’s decision to approve RU-486 have been all
over the map, but one thing nearly everyone in the press seems to hope is
that the availability of the abortion pill will take the issue out of
politics. When people say that, it sounds so reasonable, so neutral. But
what they are really saying is, "Maybe this will silence those annoying
pro-lifers." Even the Supreme Court once pronounced that abortion foes
should simply shut up. Hadn’t the Supreme Court decided the matter? But, of
course, if this issue does not belong in the political realm, what does?
The Food and Drug Administration has now joined an Orwellian world in which
words mean their opposite. By statute, the agency must find before approving a
drug or device that it is "safe and effective." Manufacturers of other drugs
approved for use by pregnant women must prove that the medicine will not harm
the fetus. In the case of an abortion pill, things get confused. Mifepristone
(RU-486) can rid a woman of an early pregnancy, so it is mostly safe for her,
but it is obviously anything but safe for the fetus. This did not give the
bureaucrats at FDA any pause.
As for those who hope the introduction of this drug (actually two drugs) will
end the debate about abortion - not likely. Taking Mifepristone is not like
popping a Tylenol or even like taking the combination of drugs known as the
"morning after" pill. Let’s start with the basics: No pregnancy ends without
some pain, some risk to the mother and some blood. A very early natural
miscarriage is the least traumatic to the mother. But as soon as the pregnancy
has taken hold for a few weeks, ending it - naturally or through abortion - is
not a simple or easy matter.
The first stage of Mifepristone is an anti-progesterone drug that causes the
lining of the uterus to break down. The loss of the lining leads to bleeding.
The next stage of the drug contains prostagladin, a hormone that causes the
uterus to contract. In effect, prostagladins produce a miscarriage. During this
phase of the "medical abortion," bleeding and cramping can be severe and
associated with diarrhea and vomiting. The bleeding is actually more profuse
than that associated with surgical abortions, and in about one in 500 cases,
women require a trip to the emergency room and blood transfusions. There are
also about 5 percent of women whose pregnancies are not completely ended by
these drugs, and these women require a surgical abortion to finish the job.
The whole course of the medical abortion is three days. That’s a long time to
spend in pain.
Because the drug is potentially dangerous to the mother, close medical
supervision is required. It is also imperative that the doctor who dispenses
these drugs be able to determine, through ultrasound, that the patient does not
have a tubal pregnancy. Doctors will also discover that becoming an "abortion
provider" will subject them to myriad regulations; some will have to provide
preabortion counseling, others to notify the parents of underage girls. In many
states, abortion providers are subject to regulations on how wide the hallways
of their offices must be, how hot the water from the tap may be, and how much
air flow circulates. Several states require that fetal remains be examined. One
state requires that fetal remains be buried. Many physicians might just beg off.
Use of this new drug also requires a high degree of body awareness on the
part of the woman. The drug is safe (for the mother) only until the 49th
day after the start of the last menstrual period (or about 35 days after
conception). This may cause confusion, particularly with young pregnant girls
who have trouble facing up to the fact that they are pregnant. Mifepristone
permits only about a three-week window for girls to make up their minds. Many
will miss the mark and wind up at the abortion clinic just as before.
So RU-486 will not end the debate, nor will it make the issue simply go
underground, as many seem to hope. The moral question will stay with us and
continue to divide us.
Mona Charen, a former editorial writer for the National Review, was a
member of the communications staff in the Reagan White House.