(5 of 7)
Even if more doctors offer mifepristone, there remains the question of how many women will choose it. The women who took part in clinical trials represented a cross section of society, with a range of reasons for opting for the drug. Asian women were twice as likely as others to choose mifepristone because they considered it safer; white women were twice as likely to use it as nonwhites because they considered it more natural. More educated women chose it because they wanted to show support for broader choices and because they wanted to avoid surgery. Nearly all the women in the study found the drug highly acceptable and would recommend it to others.
Yet the women in the trials were a self-selected group. For the general population, the pill is a new option, but not an easy one. It is not likely to be less expensive than surgical abortion, given the number of doctor's visits and the possibility that the pills will sell for $200. And it is not as though you take a pill and the baby disappears. Medical abortion, as opposed to surgical, is a multistep process, requiring three visits to the doctor over a period of two weeks. The first visit is to make sure the pregnancy is still early enough for the pill to be used safely, which will automatically exclude many women who don't realize they are pregnant until more than 49 days after their last period. Two sets of pills are required--first mifepristone, then, two days later, misoprostol, to trigger contractions and expel the fetal tissue--and that can cause nausea, heavy bleeding and painful cramping. After about 12 days, a woman must return to the doctor to confirm that the abortion was successful.
Some doctors see a psychological advantage to the new procedure by giving patients the sense that the process is more natural because their body is doing the work, not a surgeon's vacuum. "My patients are usually under a lot of stress and are trying to find the appropriate action to take," says Dr. Carolyn Westhoff, a professor of obstetrics, gynecology and public health at New York's Columbia University, who has conducted many of the mifepristone trials. "For someone who feels backed in a corner, it is good to feel you have a choice."
That is not to say mifepristone makes abortion morally simple. In fact, some doctors argue the opposite. Carole Joffe, a sociologist of reproductive health and visiting professor at Bryn Mawr College, believes mifepristone could make abortion "more emotionally wrenching because women who take mifepristone experience something like a miscarriage, where they have to confront the product of conception." Women who undergo surgical abortions don't usually see the fetus. With mifepristone, a woman typically passes large blood clots in the toilet within 24 hours after taking the second pill.
"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.