Universe Column for March 28th
By David Alton
Earlier this month the Health Minister, Melanie Johnson, met with a delegation from the All-Party Parliamentary pro-Life Group to discuss the implications of do-it-yourself abortions using the drug RU486. The powerful House of Commons Health Select Committee had called for women to be allowed greater access “to early medical abortion in a wider range of healthcare settings”- and Jim Dobbin MP, Chairman of the pro-Life Group, was determined that ministers should hear the other side of this story.
The Select Committee argued that do-it-yourself abortions would help reduce the number of late abortions and would be “a more cost-effective use of NHS resources.” They had nothing to say about the risks to women’s health or the two cases currently before the Coroner’s Courts, involving two women who died. Surprisingly, the Committee on Safety of Medicines has not asked to consider these cases.
Predictably, support for the Select committee has come from the British Pregnancy Advisory Service (BPAS) who have been pressing the Government to approve a pilot study of 500 home medical abortions using RU 486.
Pro-abortion groups like the BPAS have always been unhappy with what they regard as the ‘medicalisation’ of abortion. They oppose the requirement that two doctors must currently authorise each abortion, that abortions must be performed by a “registered medical practitioner” (Abortion Act 1967 section 1(1)) and that abortions must be carried out in an NHS hospital or an approved independent sector place (section 1(3)) – which should surely render it illegal to prescribe RU486 for abortions.
Pro-abortion groups see increasing access to early medical abortion as a means of reducing the influence of the medical profession over the provision of abortion, as a means of putting the entire responsibility for the decision to abort a pregnancy onto the woman involved. They are well aware of the mounting anecdotal evidence that many junior doctors find abortion distasteful and exercise their right in law to opt out of performing them.
The Government’s response to the Health Select Committee’s report in September last year was not at all reassuring. “We are actively considering what non-traditional settings may be suitable for medical termination… Two pilot sites have now been identified the purpose of which is to enable the Government to define a “class of place”. No “class of place” will be approved unless the Government is content that a woman’s safety is not at risk.”
But as Jim Dobbin has correctly argued, the dangers and risks far outweigh any benefits.
The RU 486 technique actually uses two powerful synthetic hormones with the generic names of mifepristone and misoprostol. In the UK medical abortion is used for pregnancies of nine weeks or less.
The RU 486 procedure requires at least three trips to the abortion facility. In the first visit, the woman is given a physical examination, and if she has no obvious contra-indications (“red flags” such as smoking, asthma, high blood pressure, obesity, etc., that could make the drug deadly to her), she swallows the RU 486 pill, mifepristone. RU 486 blocks the action of progesterone, the natural hormone vital to maintaining the rich nutrient lining of the uterus. The developing baby starves as the nutrient lining disintegrates.
At a second visit 36 to 48 hours later, the woman is given a dose of artificial prostaglandins, usually misoprostol, which initiates uterine contractions and usually causes the embryonic baby to be expelled from the uterus. Most women abort during the 4-hour waiting period at the clinic, but about 30% abort later at home, work, etc., as many as 5 days later. A third visit about 2 weeks later determines whether the abortion has occurred or a surgical abortion is necessary to complete the procedure (5 to 10% of all cases).
It is this dose of misoprostol that the BPAS are pressing the Government to allow women to take at home, away from the clinic.
There are are several serious well documented side effects associated with RU 486/prostaglandin abortions, including prolonged and severe bleeding (up to 44 days), nausea, vomiting, pain, and even death. At least one woman in France died while others there suffered life-threatening heart attacks from the technique.
At least 4 women have died from RU 486 in North America and at least 13 have required blood transfusions due to excessive blood loss.
In 5-8 % of cases RU 486 causes severe complications.
Danco, the drug’s manufacturer, has reported at least 400 adverse events since RU 486 was first approved in the US by the Food and Drugs Administration (FDA).
In April 2002 the FDA issued a warning to all healthcare professionals about the dangers of medical abortion, particularly if the pregnancy is ectopic .
In September last year in California , an 18 year old girl, Holly Patterson died after taking the abortion pill RU 486. The County Coroner determined that the abortion pill produced an incomplete abortion which caused an inflammation of the uterus and produced a septic shock that resulted in Holly’s death.
The California Department of Health Services and the FDA’s Centre for Drug Evaluation and Research are conducting investigations into Holly’s death. In the light of Holly’s death the RU486 Patient Health and Safety Protection Act has been introduced into the US Congress in an attempt to establish restrictions on the prescription of RU 486 .
Even China has banned all pharmaceutical sales of the drug citing safety concerns.
Long term effects of the drug have not yet been sufficiently studied, but there are reasons to believe that RU 486 could affect not only a woman’s current pregnancy, but her future pregnancies as well, potentially inducing miscarriages or causing severe malformations in later children.
Listen to this admission from the manufacturers: “As Abortifacient procedures go RU486 is not at all easy to use. In fact it is more complex to use than the technique of vacuum extraction…a woman who wants to end her pregnancy has to “live” with her abortion for at least a week using this technique. It’s an appalling psychological ordeal”. (Edouard Sakiz, Chairman Roussel-Uclaf August 1990)
At a news conference on 17 May 2002 , Dr Richard Hausknecht, medical director of Danco, the company which manufactures RU486 for the American market, admitted, “it (RU486) is not safer than a surgical abortion”.
So, before authorising pilot studies or general use there are myriad safety, legal and ethical issues to resolve. Failure to do so will result in women dying and eventually in class actions in the courts against the NHS.