An examination of the RU486 abortion drug and its medical, ethical, & social challenges.
In August 2012, the Therapeutic Goods Administration (TGA) announced that it would loosen restrictions on access to the abortion drug Mifepristone Linepharma (RU 486) and GyMiso (Misoprostol). [i] The drug has been available under tighter regulation since 2006 and is currently available for women who are up to seven weeks pregnant.[ii] Media hype and political debate have muddled the medical and social risks of RU486. Australians, especially women, have been largely deprived of a civic discourse around the drug and its implications for our society. We believe women deserve to know the facts to make fully informed decisions.
RU486 medical abortions, as distinct from surgical forms of abortion, allow a women to carry the abortion out herself after consultation with a doctor and provision of the necessary drugs.[iii]
Medical abortions involve a combination of two drugs. The first is called Mifepristone which blocks the hormone progesterone from reaching the cells of the uterus, causing endometrial deterioration[iv]. This starves the embryo of nourishment, leading to its death.
Approximately 24-48 after taking the Mifepristone the woman takes the Misoprostol, causing the uterus to contract and expel the dead embryo and placenta.[v] The process is compared to experiencing a miscarriage at home.[vi] The woman may experience symptoms such as nausea, vomiting and chills accompanied by bleeding and painful cramps and contractions within a very short time after taking this second drug.[vii]
What are the adverse effects & potential complications of RU486?
There are an extensive number of risks and adverse effects associated with RU486. For this reason, the drug may only be taken after consultation with a medical practitioner.[viii] Even with medical consultation complications caused by the drug RU486 still arise and a woman may be confronted by them in her home.
A recent Australian study has found that the risks associated with medical abortion are significantly higher than those associated with surgical abortion.[ix] The study shows that 5.7% of women undergoing medical abortion require admission to hospital due to complications compared to 0.4% of women following surgical abortion.[x]
Other complications identified by the study include:
>>>> The Risk of Infection: infection rates following medical abortion are 1 in 480 for medical abortion compared to 1 in 1500 for surgical abortion.[xi]
>>>> The Risk of haemorrhage: is 1 in 200 for medical abortion compared to 1 in 3000 for surgical abortion.[xii]
Other studies also demonstrate a much higher incidence of adverse effects after medical abortion than after surgical abortion.[xiii] The Finnish study of 40,000 women found the incidence of haemorrhage in women who had undergone medical abortions to be at 15.6% compared to 2.1% of women who had undergone surgical abortion.[xiv] Not only are the adverse effects more frequent in medical abortion, they often take place in an environment which is not conducive to addressing them – that is in the woman’s own home away from medical care.
The Finnish study also found that, after going through the process of a medical abortion 5.9% of women required a follow up surgical abortion.[xv]
Can RU486 have a harmful impact on a woman’s mental health?
The psychological harms medical abortion may have on women should also be considered. Women undergoing medical abortion have at least the same risk of up to 30% experiencing serious prolonged mental health problems as women who undergo surgical abortions.[xvi]
The added burden of the woman more actively participating in the abortion by taking pills, the trauma of seeing theembryo expelled, and the higher incidence of complications means that the psychological risks of abortion may prove to be higher as more data is gathered.[xvii]
Have there been any RU486 related deaths?
RU486 has been linked to maternal deaths, such as the death of a 16-year old Portuguese girl who died as a result of a septic shock caused by the infection Clostridium Sordellii.[xviii] Since the approval of RU486 in 2000 in the United States, the FDA has been informed of eight deaths due to serious infections following medical abortion.[xix] Australia had its first recorded RU486-related death in 2010.[xx] Since then, there have been a further three instances of women dying from RU486-related complications.
There may be an increased risk of medical complications in Australian women living in rural or remote areas who may not have emergency services as easily accessible should they experience any complications after a medical abortion.
Some additional considerations
Women should be able to fully consent to all the consequences of medical procedures. If they use RU486 to have an abortion, their decision is taken out of its social, medical and ethical context. True consent is built on understanding the circumstances and pressures that women face in crisis pregnancies. They may not be aware of all the options and alternatives available to them at this stressful moment.
There is an enormous potential for abuse of medical abortions. It is much easier for partners to coerce women into having an abortion. Underage girls are particularly vulnerable to manipulation.
A crisis pregnancy is not like the flu which can be fixed up with a few tablets. In a time of acute anxiety and stress, women need support. They would be left to endure the risks and complications alone.
Given these social and medical risks when compared with other forms of abortion, the necessity of RU486 in Australian society should be in the least regarded as contentious.
Are you pregnant and worried? Support is available. For more information regarding pregnancy and early maternity services, visit: www.realchoices.org.au
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[i] Australian Government: Department of Health and Ageing, Therapeutic Goods Administration. 2012. Registration of Mifepristone Linepharma (RU 486) and GyMiso (misoprostol). [ONLINE] Available at: http://www.tga.gov.au/newsroom/btn-tga-statement-mifepristone-gymiso-120830.htm. [Accessed 04 May 13]
[iv]A. Faundes, 2011. Erratum to “The combination of mifepristone and misoprostol for the termination of pregnancy”. International Journal of Gynaecology & Obstetrics, 115(3), 1-4.
[v] ibid., p.1
[vi] Dr Marie Stopes International. 2010. Abortion Clinic. [ONLINE] Available at:http://www.mariestopes.org.au/our-services/women/abortion#comparison. [Accessed 05 May 13]
[vii] A Faunders, op.cit. p. 2
[viii] Australian Government: Department of Health and Ageing, Therapeutic Goods Administration, op cit.
[ix]H. Messenger, E. Mulligan, 2011. Mifepristone in South Australia–the first 1343 tablets. Australian Family Physician, 40(5), 342-345.
[x] ibid., p. 343
[xi] ibid., p.344
[xii] ibid., p.344
[xiii] M,. Niinimaki, 2009. Immediate Complications after Medical Compared with Surgical Termination of Pregnancy . Obstetrics and Gynaecology, 114(4), 795-804
[xiv] Ibid., p. 795
[xv] Ibid., p.795
[xvi]D. M Fergusson, L.J Horwood, L. J. et. al. Abortion and mental health disorders: evidence from a 30-year longitudinal study, British Journal of Psychiatry, 193(6), 444-451
[xvii] Real Choices Australia. 2012. Surgical Abortion, Procedure and Risks. [ONLINE] Available at:http://realchoices.org.au/resources/surgical-abortion-procedures-and-risks/. [Accessed 04 May 13]
[xviii] T.Reis, C. Chaves, et. al. 2010. A Clostridium sordellii fatal toxic shock syndrome post-medical-abortion in Portugal. In 21st European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) 27th International Congress of Chemotherapy (ICC). Milan, Italy, 7 – 10 May 2011. Milan: European Congress of Microbiology and Infectious diseases.
[xix] U.S Food and Drug Administration. 2010. Mifeprex Questions and Answers. [ONLINE] Available at:http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111328.htm. [Accessed 05 May 13].
[xx] S. Donovan, 2012. First RU 486 death recorded. [ONLINE] Available at:http://www.abc.net.au/worldtoday/content/2012/s3456632.htm. [Accessed 05 May 13].
Termination of Pregnancy, (2005) Royal Australian and New Zealand College of Obstetricians and Gynaecologists Planned Parenthood of Australia, Risks of Abortion Procedures (accessed here: http://www.ranzcog.edu.au/documents/doc_download/480-termination-of-pregnancy-a-resource-for-health-professionals.html)
Maarit Niinimaki, M.D (2009) Immediate Complications after Medical Compared with Surgical Termination of Pregnancy, Obstetrics and Gynecology.
van Oppenraaij, R. H. F., Jauniaux, E., Christiansen, O. B., Horcajadas, J. a, Farquharson, R. G., & Exalto, N. (2009). Predicting adverse obstetric outcome after early pregnancy events and complications: a review. Human reproduction update, 15(4), 409–21. doi:10.1093/humupd/dmp009.
Marcia Riordan, Chemical Abortion in Australia (online). Chisholm Health Ethics Bulletin, Vol. 15, No. 2, Summer 2009: 6-9. Availability: <http://search.informit.com.au/documentSummary;dn=653669932513069;res=IELFSC> ISSN: 1443-3591. (accessed May 13).