Now America may be about to find out whether either side is right. This summer NEWSWEEK was granted extraordinary access to the clinical trials of RU-486. Named after its French manufacturer, Roussel Uclaf, it is called milepristone in the United States. For the last year the New York-based Population Council (a private research and advocacy group) has run tests of the safety and efficacy of mifepristone among 2,100 women at 17 clinics. The experiences of the women at two of these clinics-Aurora Medical Services in Seattle and Planned Parenthood of Westchester and Rockland in White Plains, N.Y.-show that medical abortion is neither the panacea that pro-choicers believe nor the nightmare that pro-lifers dread. Their experiences also show that abortion by any means will never be just another trip to the doctor. This is the story of two women who volunteered to test mifepristone.
Becky, 30, is a full-time geology student and a married mother of three daughters. Her youngest, 4, has spina bifida, a congenital defect that exposes part of the spinal cord; the little girl needs a ventilator at night and requires near round-the-clock nursing. Becky and her husband, Richard (who asked that their last name not be used), did not want to risk bringing another crippled child into the world. Becky, a cherubic Hispanic woman whose brown bob is pulled off her face with a white cloth headband, has chosen Aurora because she had two surgical abortions as a teenager. She still remembers the slurping noise of the suction machine, the loneliness, the doctor’s coldness. “It’s surgery,” she says. “You get all afraid you’re going to die. When they close the door on that tiny little room and that suction machine goes on, it’s terrifying.”
Sarah (not her real name) is a waitress and single. Her diaphragm failed one morning when she made love with her boyfriend, Neal, a bicycle messenger. In addition to not feeling ready to be a mother, Sarah, 25, had done a fair amount of drinking and smoking before she realized she was pregnant, and worried about the health of the fetus. She had resigned herself to another suction abortion-she had had one when she was 18-until she heard from a friend about the abortion pill.
Becky is eight weeks pregnant when she arrives at Aurora one Wednesday morning in July. The nurse-midwife, Beth (who didn’t want her last name revealed for security reasons), explains how mifepristone blocks the effect of the hormone progesterone, without which the uterine lining sloughs off as during a menstrual period and a pregnancy cannot continue. The drug misoprostol, taken two days later, induces uterine contractions that expel the fetus. Beth gives Becky a pelvic exam, a blood test and a sonogram to be sure she is not more than nine weeks pregnant, the cutoff for a medical abortion (chart, page 68). Becky decides to go ahead with it. She swallows three yellowish oval tablets of mifepristone and goes home.
Nothing much happens at first. On Thursday evening Becky feels some back pain and bleeds a little while she fries chicken for dinner. Sarah, who took the mifepristone the same morning as Becky, has it worse. At 2 a.m. she is vomiting and reeling from a headache. “I lay there for a while, trying to figure out if there was actually anything going on,” she recalls.
On Friday morning, both Becky and Sarah return to Aurora, which is tucked discreetly into a corner of a professional building, for their three white misoprostol pills. Sarah, a tall, muscular brunette with a golden tan, gets fidgety waiting for something to happen. She goes to the bathroom down the hall and then looks over the rack of videos in the waiting room. “I’m a little nervous. I’m a little weenie when it comes to pain,” she admits. She can’t lean back in the upright chair in the waiting room. “They need some La-Z-Boys,” she says. After 45 minutes, Sarah gets cramps and decides to lie down in patient room $. She tries to get comfortable between the stirrups on the exam table (Aurora has no special beds for the medical-abortion patients). Neal sits next to the table. Sarah curls up under a blanket and tries to read her Isabel Allende novel.
The bleeding starts around 10:35. At 11:15, she dispatches Neal for what she calls “PMS pills,” big sugary doughnuts. While he’s gone Nancy, the counselor, checks Sarah’s blood pressure. “I just passed something incredibly huge,” Sarah tells her. “I’m wondering if that was it.” “Was it white?” Nancy asks. Sarah doesn’t think so. Then it probably wasn’t the sac containing the fetus, Nancy says. Sarah closes her eyes, but doesn’t sleep. When Neal returns with a dozen doughnuts, she wolfs down a sugardoughnut and half a maple bar. Neal wanders through the waiting room to offer a doughnut to Becky. “The cramps are getting a little worse,” Sarah says at 12:15. She tells Nancy that she passed another large clot, but that it sank into the toilet before she could get a good look at it. “A lot of times people just know [that they’ve expelled the fetus],” Nancy assures her. ,‘They just know." But Sarah isn’t sure at all. She is surprised by the size and number of the blood clots-many as big as a half dollar. She is mildly nauseated. Another ultrasound reveals that the sac containing the fetus is no longer viable but not whether it is still clinging to the uterine wall.
Becky fares better. Half an hour after she swallows the misoprostol, her usual chatter slows. She can’t get comfortable in the waiting-room chair. “Leave me alone,” she snaps at Richard when he tries to rub her back. She curls up in a blanket on the floor near the TV. “Oh, it hurts,” she wails as waves of cramps wash over her. “R just feels like your uterus is trying to s–t out a watermelon.” Becky takes some Tylenol with codeine, paces the hallway, eats the doughnut Neal gives her, goes into the bathroom and throws up. She says she’s “gushing” blood. She returns to her chair, rocks gently, hugs a hot-water bottle to her abdomen, tries to vary her breathing. “How long will the cramps last?” she pleads. Richard corners a nurse. She assures him his wife’s pain is normal. Becky’s face is ashen. Her limbs feel shaky. Then, suddenly, something seems to shift inside her. The pain stops abruptly and Becky relaxes, her face glistening with sweat. She exhales and leans her head back against the wall. Minutes later, around 1:20, she goes into the bathroom and yells: “Richard! Come here-look at this!” There is a fist-size glob of red and white at the bottom of the toilet. Becky can see the curled-up fetus, the size and color of a cocktail shrimp. “Look at that, honey,” Becky says to Richard. Its hands are cured into tiny fists. “It’s sad. It’s sad,” Becky murmurs, turning away.
Unlike Becky, Sarah has not expelled the fetus within 24 hours of taking the misoprostol. She is among the 10 percent of women whose mifepristone abortion takes more than a day. Sent home in the late afternoon, Sarah bleeds heavily for the next few days but manages to go in to work. The following Sun-day-nine days after the misoprostol–she is taking a shower when she suddenly expels the pregnancy sac. It doesn’t go down the drain. She scoops it up, wraps it carefully in toilet paper and flushes it away. “It really emotionally hit me,” she says later.
Despite the nine days of bleeding and cramps, and despite seeing the fetus swirling around the shower drain, Sarah preferred the medical abortion to the surgical one she had as a teenager. “It just seemed a little healthier,” she says. “It seemed a little less traumatic.” Claudia, a 23-year-old computer programmer from Connecticut who lives with her boyfriend, had an experience starkly different from Sarah’s: the night after taking the drug at the Planned Parenthood clinic she passed the fetus,without even taking the contraction-inducing misoprostol. She had never had an abortion before. “At first I cried,” she says. “It’s a mourning process. It’s respect for life. But it wasn’t guilt . . . Maybe I would have had more guilt with a surgical abortion because I wasn’t connected with it.” Becky preferred the medical abortion to her surgical ones, even though it was more emotionally draining. She wanted to experience the pain, both emotional and physical, she says. She felt she should suffer for terminating her pregnancy, since for her, as for many women who have an abortion, the certainty that she did not want to carry the fetus to term did not make the decision any less morally or emotionally ambiguous. “There was a little bit of regret about seeing [the fetus], because it had little hands,” Becky says. “I remember little fists. I felt more responsible this time.”
The clinical trial of mifepristone ended last week, and for now the drug is unavailable. Now the Population Council will spend several months collecting and analyzing the data; it hopes to submit a request for FDA approval by the year-end. Approval could come as soon as next year. Studies in Europe, as well as preliminary results in this country, suggest that the drug regimen is safe and effective. And late last month a New York gynecologist announced the results of another abortion-drug trial: he found that two common prescription drugs, used to fight cancer and ulcers, can also be used successfully to end an early pregnancy (NEWSWEEK, Sept. 11). This regimen could win FDA approval by 1997.
But it is unclear whether medical abortion would bring about the changes that pro-choice forces envision. Although the activists hope that abortion-by-prescription will be more widely available, especially in rural areas, there is no guarantee that physicians will have any more enthusiasm for it than they do for surgical abortion. There are, however, some hints. In a study scheduled for release later this month, the private Kaiser Family Foundation, a health-policy research group, finds that one third of obstetricians/gynecologists who do not now offer abortions say they would prescribe mifepristone. No matter how many doctors offer it, pro-life activists say they will have little trouble finding them. “We will be able to find out where they’re doing [medical] abortions,” vows Ann Scheidler of the Pro-Life Action League.
Whether the political landscape of abortion would change with the availability of a pregnancy-ending pill depends, of course, on how many women opt for it over surgery. A Population Council survey finds that 60 to 70 percent of women who had a medical abortion preferred it to the surgical option. But the population at large might not be so enthusiastic. In fact, medical abortions will almost certainly cost just as much as surgical abortions. They could have a higher failure rate, since surgery is almost foolproof but drugs act differently in different women. Medical abortions are also less convenient. The expulsion of the fetus could happen anywhere, any time, after the first pills are swallowed. It is not clear how many women really want to see, or dispose of, their fetus. “I think medical abortion is being portrayed as easier than it is,” says Vicki Saporta, executive director of the pro-choice National Abortion Federation. “This is not like taking an aspirin and your headache goes away.”
But these are just practical concerns. The turmoil that comes with the decision to abort will be no less ira woman knows she will double over with cramps rather than brace herself for the cold steel of the stirrups and the suction hose. Abortion-by-prescription may indeed make the procedure a private matter between a woman and her doctor once again. And that would undoubtedly make women’s ordeals easier. But never easy.
Just ask Becky or Sarah.
Though their results are the same–the termination of a pregnancy-medical and early-stage surgical abortion work in different ways. The benefits and disadvantages of three methods:
The following chart reads as follows: Row 1: PROCEDURE Row 2: SIDE EFFECTS, RISKS Row 3: COST, TIMING, STATUS RU 486 Mifepristone (RU486) pills block hormone sustaining pregnancy; misoprostol pills two days later induce contractions. Intense cramping and bleeding can lastf more than a week. Four percent failure rate. About $300. Effective until the 9th week of pregnancy. FDA may approve it next year. Methotrexate and Misoprostol A shot stops fetal cells from dividing. A vaginal suppository 5 to 7 days later induces contractions. Nausea and diarrhea in rare cases. Four percent failure rate. Drugs are $10, M.D. visits bring tab to $300. Effective up to 9th week. Could be approved in 1997. Surgery Usually vacuum aspiration of the fetus through the vagina. Performed under a local anesthetic. Slight chance of perforation of the uterus or injury to the cervix. About $300. Used from 6th to (in rare cases) 24th week. Legal, but 85% of U.S. counties have no practitioners.
title: “Blood And Tears” ShowToc: true date: “2023-01-17” author: “Ernest Belcher”
But how they did it was a different matter. They murdered the family with the utmost barbarity, then tried to cover up the fate of the family and tried to pretend it was a local decision. It set the tone for future, secretive state terror.
When [Boris] Yeltsin bowed before the [tsar’s] coffin [at the funeral of his remains in St. Petersburg last summer], it was a turning point in Russian history, like Lenin’s first speech or the victory parade in Red Square in 1945. It showed that the ceremony was not just the burial of the last tsar but the burial of a bloodstained page of Russian history. Now the Russian people must look forward and leave the past to the scholars and historians. I often quote [Alexander] Herzen, “Streams of blood and tears flow when revolutions occur, but there comes a time when we should gather the courage to step over them.” We Russians in exile also need courage; many of us are still fighting the civil war. Some are still angry at me for shaking hands with Yeltsin.
