The Pill Arrives

(4 of 4)

"You have to walk around," the nurse had told Chaya, 44, a divorced mother of two teenagers, who took the pills during the clinical trials. "Keep busy so you don't get depressed." Chaya cried when the doctor administered the first dose. She took the second set of pills at home, with her sister, and began to feel cold before the bleeding started.

"I know nothing about these things," she says, recalling the prospect of getting an abortion. The idea of surgery frightened her. "I was so scared. I was afraid of the risks." Her boyfriend had told her about mifepristone; she liked the sound of it. "Without surgery it would be less risky," she thought, "like having a period." But he had also offered to marry her, urged her to keep the baby. Her children said they would baby sit. She didn't think it would work. "I've already had my babies," she said.

The bleeding continued all afternoon, but the pain was not crushing. By evening it was mostly over. Like many women, she compares the experience to a bad period.

After years of steadily declining abortion rates in the U.S., pro-life advocates fear a reversal if the pill encourages women to view abortion more casually. For these activists, the point of the debate about late-term abortion was to draw tight the line between abortion and murder. Mifepristone, argue its supporters, makes abortion look more like birth control, "more like a standard medical treatment than something that has been marginalized and ghetto-ized," notes Boston University ethicist Annas. But even greater availability and a higher comfort level among patients do not mean the total number of abortions will necessarily rise. During the decade that the pill has been available in France, more and more women--now 29%--have chosen medical over surgical abortion, but the availability of the drug did not drive up the total number of abortions. On the other hand, surgical abortion in France does not carry the same stigma, the issue is not as divisive as in the U.S., and so the introduction of a medical alternative may have a greater impact here than abroad.

By focusing debate on the very earliest weeks of pregnancy, mifepristone does force pro-lifers to refine their arguments. "It's a whole new ball game for people in this movement," says Judith Brown, president of the Virginia-based American Life League. She hopes to convince people that even though the fetal material being expelled doesn't look like a baby, it is still an unborn child. "We will have to personalize the egg," she says. By the time a woman misses a period, sees her doctor and confirms the pregnancy, opponents note, there are already distinct signs of life. "Brain waves can be picked up as early as six weeks," says Laura Echevarria, communications director of the National Right to Life Committee. "We will be stepping up our efforts to educate people about the early development of the unborn child."

Abortion foes also plan to drive home the medical risks associated with the drug, especially if it is misused or winds up circulating through an Internet black market. "It can be banned state by state or by Congress," says Michael Schwartz, administrative assistant to Representative Tom Coburn, a doctor from Oklahoma who last year tried to bar the FDA from spending federal funds to develop any kind of abortion drug. Schwartz thinks it is inevitable that the drug will be prescribed for women who are more than seven weeks pregnant, that there will be a lack of patient compliance and that someone will die from it. "These are predictable consequences, even with the guidelines," he says.

But mifepristone's defenders counter that carrying a baby to term is six times as dangerous as ending a pregnancy, whether surgically or medically. There are certainly risks if women were to use the drug without adequate supervision, but the FDA guidelines aim to limit that possibility: a patient will receive written instructions on taking the pills, and must sign a statement swearing that she has read them and that she will agree to a surgical abortion if the medication fails.

Though the abortion debate could now land squarely back in the middle of the presidential campaign, both candidates mainly used last week's announcement to reinforce longstanding positions. While the next President can't reverse the FDA outright, he could pick an FDA commissioner and a Health and Human Services Secretary who would raise safety questions and try to tighten distribution--with the goal of making medical abortion just as hard to get as surgical abortion.

But the real battle is still likely to be waged in the streets, for now. Antiabortion activists may not change anyone's mind about the pill--but they could have an effect if they persuade enough doctors that entering this minefield is dangerous to their health and practice. The tactic has worked well for years now; in much of the country, Roe v. Wade might as well not exist, and the only way the abortion pill changes that is if doctors everywhere decide to offer it. "There are a lot of doctors who feel very strongly that women have a right to make a choice but are unwilling to wear flak jackets to work," says Dr. Diana Dell, an ob-gyn specialist at Duke University Medical Center. "I don't know where it will go."