NARAL Pro-Choice Wisconsin : Issues : Fact Sheets

Learn about what medical abortion involves, how it has evolved in the United States, and why we should make it more available.

Medical abortion involves the ingestion of a drug, Mifepristone (also called Mifeprex or RU-486), for the purposes of terminating pregnancy. In general, it can be used up to 63 days after the first day of a woman's last period. Moreover, RU-486 can be used as soon as a woman realizes she is pregnant, cutting short the requisite 7 week waiting period for a surgical abortion. In this form of abortion, a doctor proscribes Mifeprex, which a patient takes at a clinic. The initial dose is followed up several days later with a dose of misoprostol, which can be taken at home.

While surgical abortion has been legal in the United States since 1973, the advent of the abortion pill has added pressing new complexities to the debate. The FDA has conducted a number of politically charged reviews regarding if and how the drug should be used and administered. However, the inaccessibility of RU-486 in the United States has made pregnancy termination difficult for many women. Administration is costly and time consuming, placing seemingly unnecessary burdens on women who are already in difficult situations.

The history of RU-486 far overreaches its use in the United States. The drug was conceived in 1980 by French scientist Etienne-Emile Baulieu, who was actually looking for a steroid to treat ulcers. By 1988, after extensive research, RU-486 was ready for release to the French public. It was approved to terminate early pregnancy (defined as less than 50 days since conception).

Upset by the new French policy and under pressure from pro-life Christian groups, President George H.W. Bush placed RU-486 on a list of drugs banned from importation to the United States for personal use. In July 1992, a pregnant woman from California challenged the ban by bringing twelve RU-486 pills from France through Kennedy International Airport in New York. The pills were confiscated and the woman sued. The case eventually reached the Supreme Court, which ruled 7-2 to deny her request for the drugs to be returned.

Less than one year later, the election of President Clinton gave pro-choice advocates renewed hope that the ban would be lifted. In January 1993, to mark the twentieth anniversary of the landmark Supreme Court decision Roe v. Wade, President Clinton asked the FDA to assess the health and safety of the drug.

Early in 1998, the results of the study were published in the New England Journal of Medicine, which concluded that RU-486 was “safe and highly effective.” Beginning late in 1998, the Republican-controlled Congress unleashed a four-year series of bills attacking RU-486. Three attempts to ban the drug outright were proposed, however none were taken seriously and only one made it out of committee onto the floor for debate.

In early 2000, the requisite trials for the FDA were finally complete. Under the Clinton Administration, the FDA officially approved Mifeprex for limited use in the United States. Since then, six bills have been introduced into Congress to limit the use of Mifeprex. Proposed legislation included a mandated hospital stay, 48 hours of clinician supervision, or up to five doctor’s appointments. Over the past several years, anti-choice advocates have also sought to confuse Mifeprex and emergency contraception to decrease the availability of both.

France and the UK continue to loosen restrictions regarding Mifeprex, so that today it requires little more than a doctor’s prescription. However, in the US, the abortion method remains difficult to access and requires multiple doctors’ visits. In 1993, a Gallup poll showed that fifty-four percent of Americans favored the pill’s availability as a prescription, while forty-one percent opposed it, and just less than one percent had no opinion.

Medical abortion vastly expands patients’ access to abortion care because doctors, as opposed to exclusively abortion clinics, can administer the drug. However, restrictions (such as Wisconsin’s 24 hour waiting period and parental consent law) still apply.

Perhaps the greatest barrier for women seeking medical abortions is cost. The pill and administration cost between $350-$650. In addition, all patients must return for at least one follow up appointment to ensure that the abortion has been effective. If Mifeprex is not completely successful, a surgical abortion must be performed, creating an additional expense.

RU-486 offers extra privacy for women having abortions. Patients may choose to be with the support of significant others, family or friends as they undergo the procedure, instead of in a clinic. Since medical abortions are less invasive, many women feel that they are more in control, adding self assurance to a difficult situation.

The health benefits of the abortion pill are also a concern for many women. Unlike surgical abortion, the pill does not involve any anesthesia, which carries risks. Since the process closely mimics a miscarriage, many women report that having a medical abortion simply feels more “natural” to them.

Mifeprex has great potential to make abortion access more affordable and private for women in the United States. However, nationwide, there is a need to re-evaluate women’s ability to procure Mifeprex. This should include especially rural women, minorities who have been typically underserved by the reproductive healthcare community and women who may not be educated or aware of their various options when facing an unintended pregnancy. Options for increasing the availability of Mifeprex may include broader insurance coverage of abortions, more doctors routinely proscribing the drug and lessening the number of visits that are necessary to complete the treatment.