By Randall K. O’Bannon, Ph.D., NRL-ETF Director of Education & Research
Editor’s note. The following is the summary of some of the most important factors that explain the abortion industry’s push for chemical abortions in America and around the world. Over the next five days, each of the reasons given here will be fleshed out and examined in more detail.
When RU-486, the abortion pill, was approved for sale in America in September of 2000, this two-drug chemical abortion technique didn’t simply appear out of the blue. It was the result of the years of planning, research, and market analysis by the abortion industry, the culmination of a long term strategy put in place decades earlier. Today, that strategy is playing out in clinics all across America and around the world.
So what was it the abortion industry saw? And what did they hope to accomplish by adding chemical abortifacients to their already deadly arsenal? Here are five reasons behind the abortion industry’s push of the abortion pill and an indication of how far they’ve gotten in fulfilling their awful aims:
Reason 1. The Need for an Abortion Makeover
Those working every day aborting women knew that whatever ignorance existed about surgical abortion in the early days after abortion’s legalization, it quickly began to die off once women experienced the pain, the indignity, the intimidating reality of surgical abortion.
Not surprisingly, therefore, the fact that chemical abortions were not surgical abortions was one of the major selling points in the press release the abortion pill’s sponsor put out announcing the beginning of trials in 1994. Calling use mifepristone “safe,” telling women it was like a “natural miscarriage,” the Population Council assured people that “medication abortion avoids a surgical procedure,” specifically claiming, “There are no risks of anesthesia or uterine perforation or cervical canal injury, rare complications of surgical abortion” (Population Council release, 10/27/94).
That the pill did not live up to the hype, that it took longer, was indeed bloodier, more painful, and far more dangerous than women had been led to believe, was of little consequence to the abortion industry, which was able to market the “new and improved” product to a new, though largely misinformed customer base.
Reason 2. Seeing Earlier Babies as Easier Targets
In October of 1989, Harrison Hickman, a pollster for what was then called the National Abortion Rights Action League (NARAL), told attendees at NARAL’s 20th anniversary conference
“Probably nothing has been as damaging to our cause as the advances in technology which have allowed pictures of the developing fetus, because people now talk about the fetus in much different terms than they did 15 years ago. They talk about it as a human being, which is not something I have an easy answer on how to cure.”
Early promoters of the abortion pill, like Lawrence Lader, explicitly linked the push for the abortion pill with efforts to shift the argument to earlier stages of fetal development in his 1991 book, RU-486.
“… RU-486 works at such an early stage that moderate opponents of abortion might be persuaded to reexamine their objections in light of the drug’s biological significance.”
Lader goes on to argue, falsely, that the aborting woman encounters “no sign of personhood,” quoting a doctor who researched the pill saying that, at this stage of fetal development, “You can’t even find it.”
Yet women who’ve had these abortions report seeing not “blobs of tissue,” but fetuses with “tiny fists” (Newsweek, 9/18/95), “two dark spots like eyes and a little skeleton not quite formed” (Health, Jan-Feb, 1995). The New York Times talked to women who took the abortion pill who warned women who did not want know when the embryo came out that they would not like the procedure. “With this method, you are aware of everything that is happening,” one women told the Times (NY Times, 10/28/94).
Unless they have done their own research, or found more comprehensive material from reputable pro-life sources, women are not likely to hear about this until maybe after they’ve paid their money and actually encountered their aborted child.
Reason 3. Finding New Allies, Expanding to New Areas
Though they imagine themselves as heroes, at their more candid moments, abortionists acknowledge their doubts and admit that they are not well respected in the medical profession. Colorado Abortionist Warren Hearn told the New York Times in 1990 that abortionists “are treated as a pariah by the medical community… At best, we are tolerated” (NY Times, 1/8/90).
Despite the new packaging and the promise of easy money with chemical abortions, doctors continue to resist. Some for moral reasons, others for practical ones. But one of the explicit aims of those who pushed to bring RU-486 to America was to recruit new allies, to make doctors feel like they were somehow less direct agents of the killing, to make abortion something that could be more cheaply and discreetly added to a doctor’s practice.
Though phrased in terms of “increased access,” the clear aim is to increase the numbers of doctors and locations offering abortion. Promoters of methotrexate and misoprostol–an alternative chemical abortion regimen uses as a stop gap before RU-486 and misoprostol obtained FDA approval in 2000–said it more directly:
“Perhaps the greatest advantage of medical abortion is that it can take abortion out of the clinics and distribute it among many physicians’ offices, particularly in many areas of our country that do not have abortion services.”
Eleanor Smeal, head of the Fund for the Feminist Majority, a major fundraiser for U.S. trials of RU-486, told the San Francisco Examiner, “More doctors will be willing to write a prescription… It’s easy to administer, and they don’t have to do an invasive procedure” (SF Examiner 8/3/94).
Despite initial expressions of interest, however, once government approval came, few doctors ordered and offered the pills when they found out what was involved. Costs of the pills ($90 a pill for the recommended three pill dose of RU-486) were an issue, as were the three expected visits over a two week period. Few wanted to be responsible for answering the phone should a woman call in the middle of the night with an emergency.
Some of these were addressed by the abortion industry which pushed an alternative off label protocol (see Reason 4 below).
But where growth took off was not so much at the offices of private practice Ob-Gyns, general practitioners, or pediatricians, but at smaller “family planning” clinics which previously were neither equipped nor staffed to offer surgical abortion.
For example, by 2010, Planned Parenthood, the nation’s biggest abortion chain, had added chemical abortion to more than a third of its clinics, including 122 which offered only chemical and not surgical.
Planned Parenthood giant Midwest affiliate, Planned Parenthood of the Heartland, took the expansion to its horrible, but logical extreme. PP of the Heartland offered “web-cam” abortions at sixteen of its smaller, often rural Iowa affiliates.
Women teleconference with an abortionist back in Des Moines via the internet, who looks at the woman’s records and conducts an “interview.” If satisfied, he clicks his mouse, triggering the release of a drawer at the woman’s location, in which the abortion drugs are found. She is never actually physically examined by the doctor and simply calls a hotline – or maybe travels miles to the closest ER – if she has problems.
It is a situation fraught with risk, but others in the industry have expressed interest in trying something similar with their own affiliate networks.
So while the medical profession hasn’t welcomed chemical abortion with open arms, the new product has enabled the abortion industry to expand its reach into many new communities.
Reason 4: Increase Income
For all the talk about “choice” and women’s health care, never forget that those who are peddling these abortion pills are operating a business. It is a fact that explains why a business that was losing customers was anxious to come up with a new product; it explains why they have promoted a different protocol than the one approved by the FDA; and it explains why they are pushing web-cam abortions.
After abortions peaked in the U.S. in 1990 with 1.6 million, the number has dropped as low as 1.2 million. Abortion rates among younger customers had been in decline for some time and women were being more and more turned off by surgical abortion. Prices for abortions had not kept up with inflation and more and more doctors were getting out of the business.
A “new and improved” product offered the industry a chance to attract new customers or win back older ones (somewhere around 45% of all abortions are repeat abortions) who were intimidated by the risks and indignities of surgical abortion or upset about aborting unborn babies medical technology was clearly showing them to be both human and alive.
The FDA approved protocol called for women no more than 49 days past their last menstrual period to receive three pills of RU-486 after being screened and being counseled about the process (which they take there in the doctor’s office) which is to shut down the baby’s support system and cause the child’s demise. Under the protocol, the woman is to return to the doctor two days later to receive two pills of misoprostol, taken by mouth, to stimulate powerful uterine contractions to expel the tiny corpse. She is to return on day 14 to confirm whether or not her abortion is complete.
It was under this protocol that the FDA declared the drug “safe” and “effective.”
There were several things the industry did not like about this protocol, however, and it was arguing for alternate protocols even before the FDA gave final marketing approval.
RU-486 (or mifepristone) is a complex drug to manufacture and is imported from China, so it is expensive, about $90 a pill. With three of those pills running $270, the cost of three office visits, the personnel to screen and counsel the patients, this left a slim profit margin, if any. And if priced significantly higher than the surgical method, they might have difficulty selling the new product.
In the name of increasing effectiveness and decreasing side effects, the industry offered several modifications to the protocol, modifications dubiously offering improvements in either safety or effectiveness, but clearly increasing the abortionist’s profit margin and decreasing requirements for office time, space, or personnel.
The newly promoted protocol reduced the number of expensive mifepristone pills from three to one, but doubled the dose of the misoprostol, which ran only a dollar or so a pill. The National Abortion Federation (NAF) protocol allowed the woman to take the prostaglandin (misoprostol) at home, rather than returning to the office, eliminating at least one office visit. That industry protocol also extended the cutoff date by two weeks, from 49 days LMP to 63 days LMP, thereby opening the doors to a whole new group of customers. Reports indicate that many are performed even past this limit.
Web-cam abortions present an even greater potential for revenues. Rather than wasting time and gas traveling between multiple small clinic offices, an abortionist can sit at a computer at a central administrative office and, with the click of a mouse, dispense pills to different women in dozens of remote location around the state. Any place with an Internet connection can be set up as an abortion clinic.
As a consequence of such changes, chemical abortions now account for 199,000 abortions a year, or at least 16.4% of all abortions performed in the U.S. (as of 2008). How many of these women would have gotten surgical abortions had chemical ones not been available is unknown, but chemical abortion has certainly expanded the reach of the industry into whole new communities.
Reason 5: Taking Abortion to the Developing World
Though America was indeed a large market that the abortion industry wanted to tap into with chemical abortions, from the beginning the abortion pill’s promoters had a much bigger plan in mind. Early on, Etienne Emile Baulieu, the so-called “father of the abortion pill,” talked about the need for something to deal with the “demographic” problem in the world.
Supporters were happy to see RU-486 sold in France, Britain, and China, but they knew that clearing the hurdle of American approval was the key to worldwide use. A handful of European countries approved the pill in 1999, when it was on the cusp of approval in the U.S., but approvals in Africa and Asia came after that approval in 2000. Today, RU-486 is approved for use in over 40 countries around the world.
Ominously enough, however, the spread of the concept may be more deadly than government approvals. What promoters of these pills want most of all is for women to get the idea that there are drugs that they can buy and use to put an end to their pregnancies, whether their governments have approved the pills or not.
This is why there is a website, www.womenonweb.org, where women from countries where abortion is not legal can go, click “I need an abortion,” go through a short cursory medical interview, promise not to hold the organization liable, and order abortion pills to be sent to their home with instructions. There is no specific charge, but a minimal donation of 90 euros is requested (about $118).
Women with Internet access or a mobile phone can access and order from the website in twelve different languages.
Though cell phones today are found in some of the remotest sections of the planet, promoters of the abortion pill are not depending on their customers being technologically savvy or even literate. Abortion and family planning groups are promoting a special prepackaged blister pack of RU-486 and prostaglandin developed by an Indian pharmaceutical firm and marketed as “Medabon.”
What is remarkable about this packet is that it comes with step-by-step cartoon graphics illustrating not just how and when to take the pills, but also expected side effects.
Instead of the expensive RU-486 pills that may be harder to bring into some countries, several groups are promoting the use of the considerably cheaper prostaglandin (PG) misoprostol, which is normally used in the second step of a RU-486/PG abortion, as a stand alone abortifacient.
Because misoprostol has other non-abortifacient uses (e.g., as an anti-ulcer drug), it is much more widely approved and available around the world. Even where it cannot be officially prescribed for abortion, women can either get it on the black market or obtain a prescription for other purposes.
Groups like Women on Waves have set up hotlines where women in such countries can call and find out how to get it. Other groups like Gynuity are marketing “Instructions for Use: Abortion Induction with Misoprostol in Pregnancies up to 9 Weeks LMP,” a pamphlet very similar in outline and structure to the official labels or lengthy package inserts that come with most medications.
If women are in a country where abortion is illegal, they are told not to worry about their abortion attempt being discovered. If they have to go to the hospital, the Women on Waves website tells women “You could say that you think you had a miscarriage… it is not necessary to tell the medical staff that you tried to induce an abortion, you can also say you had a spontaneous miscarriage. The doctor CANNOT see the difference” (www.womenonwaves.org/en/page/702/how-to-do-an-abortion-with-pills-misoprostol-cytotec, accessed 4/10/13).
Whether their ultimate aim was more revenues or more abortions, there is no question that chemical abortion has opened up a whole new market in the U.S. and around the world. Also, sadly, there is little doubt that, whatever the new sales pitch or packaging, the result will be the same: more dead babies, more mothers’ lives in danger.
The packaging is different, but the product and the people pushing it are the same.