For a decade around the world, several million women have used a pill to end pregnancy in
its earliest weeks. Now mifepristone has crossed US borders. Also known as RU-486 or the
"French abortion pill," the drug should be ready for widespread use in the US by
2000. Like all abortion methods, mifepristone has been the subject of controversy, in part
because it promises to make abortion even safer, more effective and more accessible.
How does it work?
Mifepristone blocks the effects of progesterone, causing the uterus
to shed its lining. This dislodges the fertilized egg or embryo. A second drug,
misoprostol, is given two days after mifepristone. Misoprostol has the same effect as a
specific prostaglandin produced in the body. The drug combination of mifepristone and
misoprostol is more than 95% effective in terminating a pregnancy within the first 7
weeks.
Use in other countries
Mifepristone became available for medical abortion in France during
the 1980s. In 1988 Roussel-Uclaf, the pharmaceutical company that developed the drug and
named it RU-486, reacted to the protests of abortion opponents and removed the drug from
the market. The French government forced Roussel to return the drug to the market, deeming
it the "moral property of women." Since then, roughly 300,000 women in Europe,
and possibly more than 3 million in China have used it.
Implications for abortion in the US
Since it can terminate pregnancy so early — even before a woman
misses her period — medical abortion is more politically acceptable in the United
States. A 1998 New York Times/CBS poll showed that almost two thirds of American adults
believe women should have the legal right to have abortions performed during the first
three months of pregnancy. 1
Medical abortion also offers women more privacy, away from anti-choice violence.
Mifepristone can be dispensed in the anonymity of a doctor's office, clinic, or hospital,
away from the jibes of right-to-life picketers.
The drug also promises to make abortion more accessible. In 1996, 86% of all U.S. counties
lacked an abortion provider. A 1998 Kaiser Family Foundation poll, however, showed that
45% of family practitioners were "very" or "somewhat" willing to
prescribe mifepristone. Fifty-four percent of nurse practitioners and physician's
assistants were also "very" or "somewhat" willing to prescribe it.
Hurdles for U.S. approval
With support from President Bill Clinton, feminist organizations
jumped high hurdles to bring mifepristone to this country. Within the first year of
preliminary approval from the U.S. Food and Drug Administration, additional setbacks
delayed the drug's market appearance. Remaining threats to mifepristone even after it is
approved by the FDA include: legislative restrictions on who can provide it, and limiting
its use to doctors' offices. (Clinical evidence shows that the second drug in the regimen,
misoprostol, is effective when women administer it at home and that most women prefer to
use it this way. The preferred scenario is for clinicians to dispense mifepristone in
their offices and for women to take misoprostol at home two days later.) The possibility
also exists that the FDA will not be able to protect the anonymity of the drug's
distributors and that abortion opponents will focus terrorist attacks or boycotts against
them.
Other Potential Uses
Mifepristone's potential goes beyond early abortion. It has proven
99% effective as an emergency contraceptive. It can also be used as a monthly birth
control pill, as well as a treatment for breast and prostate cancer,
meningioma, Cushing's
syndrome, and other conditions.
By Susan Motamed
September 1999
PPFA Web Site © 1999, Planned Parenthood®
Federation of America, Inc.
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