In late 2021, it was reported that just over half of all abortions in the United States were done via oral medications. Now these pills are a central element in the political battles over abortion. And therein lies a story.
Way back in the late 1980s, scattered reports begin to appear in the European medical literature about an oral medication that could interrupt early pregnancy both safely and effectively. It was called RU-486, for the French pharmacological company Rousell Uclaf that developed it. From these earliest papers it seemed clear this could be an extremely significant development. Abortion was of course a highly politicized issue, and for years those opposed to it had found ways to make it hard to obtain safely, and even mounted physical attacks on clinicians – some of whom were murdered – and clinical settings where it was provided. Such a medication would make it difficult to target those who provided or took it. And of course most women, given the choice, would prefer a medication option to a surgical one, even if that surgical procedure was the most common one in the nation.
At the UCSF campus newspaper, I began to cover this developing medication, publishing some of the first stories on it in the country. The Europeans were far ahead of us and soon RU-486 had garnered enough evaluation to be approved in nations such as France and England. At the San Francisco Medical Society I drafted a policy resolution stating that American women and physicians should have access to this medication already approved overseas. The California and and AMA soon adopted it too – the latter garnering some national media stories. I also published a survey of California OB-GYNs indicating that many would prescribe the medications if allowed. We drew up a research protocol to confirm what was already known about the pills in France, a scientifically but not medically-indicated effort, for RU486 had already been called “the moral property of women” by the French minister of health.
At the same time, a small group of physicians and other health advocates began to meet at the medical society headquarters, seeking to find a way to speed approval of this breakthrough medication in our politicized nation. Working with a veteran New York abortion rights advocate, Lawrence Lader, we hatched a rather audacious plan: We would find a pregnant woman who wished to use RU-486, fly her to Europe to pick up the pills, fly her back, and intentionally have her “busted” for smuggling an unapproved drug into the United States, with major media there to cover it. It was also the time of a heated Presidential election between Bill Clinton and incumbent George H.W. Bush, and we wanted to insert this issue into the campaign debates if possible too.
In short, this “stunt” worked just as planned. The patient was detained, her medications impounded, and the story hit the front pages and television news nationwide, vastly expanded awareness of this medical option and the politics surrounding it. Court battles ensued, expedited due to the patient’s condition. The Supreme Court, convened just for this case, denied her the pills but declined to prosecute her or us (we heard Federal officials were considering indictments for illegal drug smuggling, but soon seemed to decide that would be very bad PR for them). Clinton vowed to bring RU486 to American women, and other leading figures weighed in in agreement. Back home, we had to hide the patient from massive media interest – we’d tried to protect her name, but one theory was that an enterprising reporter bribed the airplane seating chart out of an airline employee - but she got the care she needed. Time magazine then called RU486 “The Pill That Changes Everything.”
This big event occurred 30 years ago around Independence Day, 1992 (not our plan, honestly; it just turned out that way). However, due more to political than medical factors, it still took eight years, until 2000, for the FDA to approve mifepristone/misoprostol in this country. That was better than delaying forever, as many feared would occur, but even when approved there were restrictions attached many experts felt unwarranted by evidence, and still do, for now vast clinical experience has shown such regulatory barriers aren’t needed. Primary care providers can safely use them with patients, and many now even believe they should be available over-the-counter. Thus there is concerted research into how these medications can be used safely and effectively without such restrictions, and new advocacy for increased availability, especially in light of Roe v. Wade being overturned and very many patients in need living in areas where abortion becomes unavailable and having to travel for care. About 15,000 women per year are expected to arrive in California for this purpose; that flood of needful, often frightened and desperate women has already begun. The “right to life” radicals just don’t seem to care what their efforts mean for living, breathing women, especially poorer and disadvantaged ones.
The pills women can safely take to achieve a safe and effective early abortion have now taken center stage in the post-Roe abortion battle. Anti-choice extremists are trying hard to restrict access to them - again, much more difficult to do than for surgical abortion. They have done so in some cases, but they won’t win on this front. Three decades on, it is ironic, frustrating, and sad that all this effort is still necessary at this late date. But we won’t abandon what is right for those in need.
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