Abortion Pills on Trial

  • "I was the first one in Des Moines. Everyone was really excited on Wednesday, when I was given the first dose of medication. I made a joke that we should have a ribbon-cutting ceremony. They kept telling me I was making history.

    "I was very nauseous in a couple of hours. I threw up constantly for three days. I went to work. Luckily, there's a restroom in my department. I moved a little slower. Usually I'm very upbeat, but I wasn't for those three days. It was like food poisoning. I couldn't keep anything down.

    "I went in on Friday and took the second dose of medication. After 15 minutes there was a tiny bit of cramping, but less than menstrual cramps. After two hours the cramps got stronger, and I started using a heating pad on my belly. I went to the restroom. When I started to stand up, it was like a faucet turned on. There was a steady stream of blood. I passed a golfball-size blood clot that scared me. I thought maybe it was the fetus.

    "The cramps stayed steady. In the last 15 minutes of my appointment, I was doubled over. The bleeding was very heavy, heavier than a period. My mom drove me home. By this time, I was bleeding severely, and I had diarrhea. It reminded me of the way you bleed after you give birth. Maybe a woman that hasn't given birth might be a little more distressed.

    "I aborted at 6:30 on Friday night. I heard it fall into the toilet. It looked like a blood clot. I cried when I knew it had passed -- partly from relief, partly from sadness. I knew it was over."

    -- Patient 001

    At the Planned Parenthood clinic in Des Moines, Iowa, they are known simply as "the M&M; trials" because of the two drugs involved: mifepristone and misoprostol. But the breezy nickname fails to convey either the scientific significance or the social controversy surrounding the U.S. clinical trials of the so-called abortion pill. Although an estimated 150,000 women in Europe have used mifepristone (known there by its brand name, RU 486), the threat of consumer boycotts by antiabortion organizations discouraged Roussel Uclaf, the drug's European manufacturer, from marketing the pills in America. Instead, the company eventually agreed to let the Population Council, a nonprofit group, sponsor clinical trials of mifepristone in the U.S. Last month tests began at some of the 12 sites around the country, five of them Planned Parenthood clinics. Based on the results of these trials -- which will involve 2,100 volunteers nationwide -- the Food and Drug Administration will decide whether to approve the drug.

    Patient 001, a 30-year-old blue-collar worker, was not an obvious candidate to become an abortion pioneer. "I was brought up in a Christian home," she told TIME. "My family was pro-life, so I always said 'I could never do that.' " But by the time Planned Parenthood of Greater Iowa announced on Oct. 27 that it was looking for volunteers, she found herself pregnant and desperate. Married, with two children and "a complicated domestic situation" she prefers not to discuss, Patient 001 and her husband decided that she should take part in the trials. "I was terrified of a surgical abortion because of a friend's bad experience," she says.

    The Des Moines clinic reports no shortage of women willing to try the pills, which are free during the trial. (Eventually, a mifepristone abortion is expected to cost about the same as a surgical procedure.) In fact, inquiries have been coming in from as far away as New Jersey. To qualify, a woman must be over 18, in good health and less than 63 days away from her last menstrual period.

    On her first visit to the clinic last week, Amy,* 23, was given a medical checkup that included a Pap smear, breast exam and pregnancy test. Then a counselor took her through a series of questions about her health and her decision to have an abortion, and explained the M&M; procedure in detail. When it was time to sign a six-page consent form, Amy did not hesitate. "Not even for half a second" did she and her husband think about having the baby, she says. "We've known for over two years that two children were enough for us." Amy was then handed three mifepristone tablets, which look like slightly oversize aspirin, and a paper cup of water. For her, the decision to take the pills rather than undergo a surgical abortion was easy. "It's much more simple," she says. "To me, it sounds a lot less traumatic."

    In fact, the M&M; process can be far more taxing than a surgical abortion, which lasts for about 15 minutes, with a recovery time of roughly one day. The first dose of mifepristone, which overrides the pregnancy hormones and breaks down the lining of the uterus, usually produces only minor side effects such as nausea, headaches, weakness and fatigue. But two days later the patient returns to the clinic for a dose of misoprostol, which causes contractions of the uterus to expel the fertilized egg. This stage of the procedure can be painful, messy and protracted. Women are required to stay under observation at the clinic for four hours. Recalls Angie, an unmarried 20-year-old with two children: "I started to bleed like menstruation. But nothing really happened until the next day. I was having deep cramping when I went to the bathroom, and it was like turning a water jug upside down. I looked at the fetus and was disgusted. I flushed before I got sick to my stomach." She then had to return to the clinic 12 days later for an exam that would ensure that the abortion was complete. (The pills fail to completely expel the fetus in 4% of cases, and a surgical abortion is necessary.)

    "This requires more of a time commitment than surgery. It's a lengthy process," says Jill June, the president of Planned Parenthood of Greater Iowa. "And women will be dealing with blood that, in a surgical abortion, only medical professionals would see." Yet for a variety of reasons women are glad to have an alternative to surgical abortion. For one thing, M&M; can be done sooner in the pregnancy than surgery, which is usually performed after seven weeks. There is no anesthesia involved with M&M;, and little risk of infection or perforation of the uterus. "This is more natural for the body," says Theresa, 32, a divorced mother of four. "It's working with the body." Stephanie, a single 19-year-old who has never been pregnant before, agrees. "I didn't like abortion and I said I'd never have one. These were just pills," she said, after her first dose. "This was just like being at the doctor's."

    For now, the M&M; volunteers have been spared the gauntlet of antiabortion protesters who had at one time routinely picketed and blockaded the Des Moines clinic. A year ago, a judge ordered Operation Rescue to stay away from the facility, which has been guarded by U.S. Marshals since Dr. John Britton was shot in Pensacola, Florida, in July. But June is worried that this may be "the calm before the storm." Two weeks ago, local antiabortion activists met to strategize against the M&M; trials.

    By last week, 50 patients at the Des Moines clinic had become part of the national trials. For Patient 001 it was "a positive experience. I don't think any kind of termination of an unwanted pregnancy is easy. But the pills seem to me to be a lot less traumatic." Planned Parenthood expects many other women to agree. "The scientific genie is out of the bottle," says June. "This technology is available to the women of Europe. Now the women of America will be satisfied with nothing less."

    FOOTNOTE: *The names of patients have been changed.