By Anna Krohn
Illegal immigrant women in the Caribbean told pro-abortion researchers in 2005 that they had accessed the ulcer treatment misoprostal (Cytotec) for abortion, via the black market or false prescriptions, because they could not afford to see a doctor and could not risk the visibility of distress of their pregnancies.
They described their experience of minimally supervised or self-administered chemical abortion as involving “sangró mucho, mucho dolor” (much blood and much pain/sadness).
Haunting comments such as these reveal the risks and suffering faced by women so desperate and undersupported that they resort to “backyard” and off-licence substances to “resolve” their crises.
Haunting, too, is the rhetoric of first-world proponents of chemical abortion such as the Federal Minister, Tanya Plibersek, and a monopoly of powerful lobbyists who argue that subsidised chemical abortion will be “less harrowing”, “more private”, cheaper and more accessible to “underprivileged women” and those in remote and under-resourced rural areas of Australia.
On April 26 this year, the Pharmaceutical Benefits Advisory Committee (PBAC) recommended that Australia’s Pharmaceutical Benefits Scheme (PBS) reimburse the costs of the dual use of Mifepristone Linepharma (RU486) and the prostaglandin misoprostal (Gymiso™) for abortion.
This marked a further milestone in a campaign which began in 2006 when Federal Parliament amended the regulation of RU486 which effectively enabled the population control and abortion movement of Marie Stopes International (and its affiliate, MS Health) and 187 approved physicians to implement and research trials of hundreds of chemical abortions. MS Health invested a further $335,000 to have the chemical process assessed and more widely registered by Therapeutic Goods Australia (TGA) last year.
The TGA website states: “This will mean that only medical practitioners recognised by Marie Stopes International Australia as having completed appropriate training will be able to prescribe the medicines.” The availability of the two drugs for abortion will also be wholly managed by the sponsor, Marie Stopes.
While the taxpayer contributions strongly advocated by the Health Minister may reduce the patient contribution for the MS-patented $450-a-dose drugs (and offset MS Health’s expenditure) to around one tenth of the monetary cost, none of the other “mythic” promises can be safely vouched for.
Feminist writer, Renate Klein, who supports existing supervised surgical abortions, argues that even reduced cost and the perception of ease of access preached by the RU486 promoters will “push many more women into using the drugs instead of asking for safer suction abortion”.
It is precisely the “under-privileged” and under-resourced pregnant women who will feel the pressure to opt for what Klein has for many years described as a “second-rate, unpredictable and dangerous chemical cocktail”.
Her concerns, that the “mantra” that RU486/Gymiso is a gentler, faster and “more natural” way to terminate a pregnancy, will appeal to women who feel ambivalent or negative about the “invasive” nature of abortion, are also well-founded. The mantra is wracked by contradictions.
While popping pills can seem more instant than undergoing surgery or facing the other options of continuing with a problematic pregnancy – to be considered safe, chemical abortion involves a whole safety net of clinical visits to monitor the precarious and unpredictable risks posed by the abortion cocktail.
In France, where RU486 has been widely available, the official Health Minister Dossier advises that medical practitioners follow a 4-5 step process over several weeks.
These steps include: a) diagnosis of pregnancy and monitoring of the nature and stage of pregnancy [chemical abortion is only “effective” up to 49 days of gestation] b) a regulatory 8-day “period of reflection” for the mother c) signing of a consent and risk-notification form along with the clinically supervised administration of RU486 tablets) the return in two days for dosage of uterine contraction/cervix softening misoprostal [with the option of staying at the clinic while contractions occur and the “embryo and placenta are expelled”] e) the woman’s return to the clinic to check for dangerous side effects such as excessive bleeding or retained placenta or foetal parts.
Far from de-medicalising abortion, the chain of precautions suggests intense medical involvement.
In China, chemical abortion is considered too labour intensive for practical use in larger hospitals. On the other hand, it removes the medical practitioner from the stark reality (and perhaps the litigation) of surgical abortion.
As Renate Klein suggests, “It’s just easier for doctors to hand out pills than to do the abortion themselves”.
What if the woman self-administers the drugs in the “privacy” advocated by the RU486 supporters? What control does this give her? The “effectiveness” is only recommended for women up to 49 days pregnant or who do not have an ectopic pregnancy and, in France, it is not advised for any woman over 35, or who smokes heavily or with pre-existing conditions such as cardiovascular disease, high blood pressure or epilepsy.
However, even correctly administered, drugs in tandem may fail to complete abortion in up to 10 per cent of cases, “requiring” a second surgical intervention, more so if the woman somehow fails to follow the mifepristone with misoprostal or falls off the medical radar – surely more likely if she belongs to the purported target audience of marginalised or remote populations.
Even the Australian Marie Stopes-promoted patent, Gymiso product information sheet issues warnings for drastic events which are associated with prostaglandin in their selective trials: “Bronchospasm”, heart crises, risks of severe bleeding and, in up to 7-10 per cent of cases, the need for follow-up surgical abortion.
Reported side effects from other studies echo the grim accounts of the migrant women of the Caribbean – but are not counted as “significant” – fever, severe pain, long-lasting bleeding, severe gastric symptoms and vomiting.
What is not noted either is the incidence of toxic shock and the “high risk of infection” noted by studies in US and Canadian trials.
One study suggested that “RU486 affects the innate immune system”, thus leading to bacterial infection. (Reported in the Women’s Forum of Australia submission of 2005.)
Ironically, as well as being dangerous for these reasons, abortion by RU486 is also likely to be more harrowing and haunting as women will be fully aware of the painful uterine wracking contractions which serve as a tragic but possibly lonely parody of labour.
As Respect Life advocate and researcher, Marcia Riordan, observes, “we do not need another abortion method (still less a risky chemical one): whichever way it is done, abortion is reflection that as a society we are not offering real options.”
Anna Krohn lectures at the John Paul II Institute for Marriage and Family in Melbourne.
By Beth Doherty
As a young woman of childbearing age, I have watched with interest the debate on RU486.
The last time RU486 was discussed at any length in this country was seven years ago when Opposition Leader Tony Abbott served as Health Minister under the Howard Government. It became available in Australia at this time.
Now, the Pharmaceutical Benefits Advisory Committee is proposing RU486 be subsidised under the PBS, which would reduce the cost from $375 to $12.
Given the kerfuffle seven years ago when then Health Minister Tony Abbott could decide whether RU486 was imported or not, isn’t it ironic we are waiting on the decision of another health minister?
Superficially, one might argue that reducing the cost of a drug is a good thing. However, seven years ago when this was last debated in Parliament, a young woman working for a pharmaceutical company pointed out that “RU486 is not like any other drug.
It is not designed to prevent, treat or diagnose an illness, defect or injury. It is not therapeutic. It is designed to cause an abortion that will end a developing human life.”
The issue of abortion, unplanned pregnancy and how our society responds to women have always been issues of interest, particularly to the churches. They continue to lead to bitter debate.
I write this piece with the know-ledge that I, and many women, could potentially find myself in a position where the use of such a drug could be a question, and I find the possibility of its wide availability a cause for concern.
I stand in solidarity with women who find themselves in the situation where they feel they have no other choice, and passionately seek to find ways to walk with them in love and help them seek other alternatives and appropriate support. (See: www.walkingwithlove.catholic.org.au and www.godsolovedtheworld.com.)
Under the guise of helping women, a proposal to cover RU486 under the PBS ignores the truth of what this drug is. RU486 is often referred to as the “abortion” pill and, by taking it, women will have the experience of a chemical abortion.
Fr Kevin McGovern wrote in Eureka Street on May 2, explaining the use of RU486: “The ‘abortion drug’ RU486 kills embryos. RU486 or mifepristone destroys the lining of the womb so that the developing embryo is detached, deprived of nutrients and dies of starvation.
A day or two later, another drug called misoprostol is used to induce contractions and to expel the now-dead embryo.”
The very thought of this taking place inside a woman’s body while she goes about her daily business seems desperately sad, both for the woman and the life inside her, and does little to commend any benefits of the drug’s use.
This is not simply an attempt by churches and pro-family groups to prevent societal progress. In fact, such progress would merely show a society which no longer values its most vulnerable members – that is, women facing an unplanned pregnancy and children.
When Health Minister Tanya Plibersek considers whether to subsidise the abortion drug RU486, I want her to think about how we can support women to take a different path.
I want her to think about how we can achieve a more child-friendly community. Really, I want her to consider whether an operation or drug can really provide the answer to a difficult social problem.
All too often in Australia, we have had highly charged debates on abortion. A parliament or a minister makes a decision, the issue sinks back into obscurity and women are again obliged to make lonely decisions by themselves because we are told the choice is theirs alone.
No longer is pregnancy a cause for joy or celebration; it is something the woman must simply “deal with in silence”.
Governments are great at rolling out the safety net but, often by doing so, wash their hands of responsibility. Their primary focus is on whether you, as a statistic, fit the entitlement.
There are so many other ways we as a community can respond to women who find they are pregnant in difficult circumstances than to provide an operation or abortifacient drugs.
Women taking RU486 would pay $12 to end an unplanned pregnancy. The process takes place in relative silence. Her mental health is at great risk of untold trauma through this experience.
She will experience all the physical effects of abortion or miscarriage: physical cramping, pain, and bleeding – and eventually will expel the embryo after a number of days.
It is said that pain and bleeding is worse for women with the use of RU486 than with a termination undertaken at a medical facility, and that, often, the embryo or its parts remain. Women often therefore need to undergo surgical treatment anyway.
Over the first six years of RU486 being available on a limited basis in Australia, the TGA received 792 reports of adverse affects. Most of these pertained to parts of the embryo remaining (579); 126 required surgical abortion.
One woman died in Australia from infection in 2010 after using RU486.
The Government should be offering a broad policy approach to assist women who have unexpected pregnancies. More importantly, we all should strive in love and solidarity to walk with women finding themselves in a difficult and sometimes embarrassing situation.
Policies on sexual and reproductive health need to have a social justice approach to eliminate the factors preventing women taking a life-giving course, especially for women who are young and marginalised.
We can all do more to be more welcoming of children born in difficult circumstances and to be more supportive of their mums.