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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."