Observers of the abortion debate disagree about nearly every topic, but for the last decade, one prediction has won pretty near consensus: When RU-486 arrives, it will change everything. Now that the FDA has approved the "abortion pill," we'll get our first experience of an all-chemical abortion--what some pro-lifers call a "human pesticide." Previous methods involved a direct surgical removal of the child, but RU-486 will be an inside job.
For doctors, there is no need to hang out an "abortionist" shingle or move to a separate clinic. In a Kaiser Foundation survey, 45% of family-practice doctors said they would be willing to dispense RU-486, though only 3% had ever done a surgical abortion. Abortion would no longer be a clinic event, but diffused broadly through the offices of all kinds of doctors.
Increasing availability suggests increasing numbers and approval. The average American, neither strongly pro-life nor strongly pro-choice, tends to think that abortion is OK as long as it doesn't look like a baby yet. RU-486 delivers on that queasy-conscience need better than surgical abortion does. Some pro-choicers hope the pill's popularity will force pro-lifers to give up the fight for the smallest unborn children.
All in all, RU-486 looks superficially like a disaster for the pro-life movement. Instead of abortion being a traumatic and bloody process, it will be irresistibly convenient. You just pop a pill, right?
Not so fast. There are reasons to think American women may not love RU-486 as much as pro-choice activists hope they will.
After all, not many easy-poppin' pills induce days of bleeding, accompanied by pain and nausea. RU-486 is rough on the system, because it is, after all, intended to destroy a healthy process. Intentionally eating a week-old hamburger is a reasonable analogy. For some women, the experience is only unpleasant, but for others it's more serious.
In one French drug trial, 1.4% of the women needed medical intervention to stop the bleeding, with some requiring hospitalization and transfusions. In terms of medical risk, the percentage is tiny; but in terms of word-of-mouth, it could loom large. If every abortion in a typical year were an RU-486 abortion (not likely, but theoretically possible), the number of women needing medical care would be 21,000.
While medical evidence is often enough to convince people that RU-486 is bad news, there's another reason that women may not be too fond of the abortion pill.
"A woman who has an RU-486 abortion will have to face the devastating realization that this abortion was not done to me, but I myself was the active agent in causing the destruction of this emerging human life," says Guy Condon, executive director of the Care Net chain of pregnancy-care centers. "The psychological impact will be more devastating for the woman who uses RU-486."
In a surgical abortion, the woman lies passively on a table while gowned strangers on the other side of a drape take care of things in minutes. She can distance herself from the event and doesn't have to deal directly with its material outcome. In an RU-486 abortion, the experience goes on for days, and there is no one there to shield her from its effects.
David Reardon, director of the Elliot Institute and an expert on post-abortion grief, says that because the woman is the agent of the abortion, she loses one of the "crutches" that would otherwise help her fend off post-abortion grief: "She can't blame the abortionist." Reardon adds that the response to RU-486 may be quite different from the response to suction abortion, perhaps resembling the grief that often follows a late-term abortion.
Peggy Hartshorn, president of the Heartbeat International chain of pregnancy centers, recalls an incident where this delay was a factor. "One of our affiliates counseled a woman who was taking part in a trial of RU-486 and having second thoughts. She was in the midst of the procedure, and it was very traumatic for her. The process is really revolting to go through."
Not only does the women feel increased responsibility for the process, not only is it a long and harrowing time, but it also may be a lonely time. There is no team of efficient clinic workers to clean up and discard evidence of the lost life. "It's a horrific scenario," Condon says. "This is not the kind of sorrow that is tinged with the positive, as in 'I had to make this sacrifice in love, though it hurts right now.' It's a despairing sorrow, destructive to the being of that woman."
Of course, most women will not see their fetus. Since RU-486 can only be used in the earliest weeks of pregnancy, the child is still very small, at most two inches long. Yet if the child is seen, the effect is profound. A 30-year-old television producer who used the pill told researchers, "I wanted to reach out and touch it," she said. "It was so small, I thought. In eight months this could have been a baby."
A study of RU-486 in St. Louis attempted to find out if feelings about the procedure changed over a modestly longer stretch of time. Researchers interviewed women at two weeks after the abortion, and again 6-8 months later. While most were satisfied with the experience at both points, by the later interview there was more guilt, and more doubts about whether it had been the right decision. These authors conclude with a call for much longer-term following of women, so that results at 5, 10 or 20 years could be known.
Other studies have compared RU-486 with surgical abortion. A 1994 study in Aberdeen, Scotland, found no difference in women's emotional reactions to either method, 16 days after the procedure. In 1991, a British study found that 25% of those who had RU-486 said they would change to another method in the future, compared with only 6% of those who had a surgical abortion. Those who wouldn't repeat the RU-486 experience were more likely to be younger, childless, to have needed more analgesia, and "to have seen the products of conception."
Still, with such a new drug, a variety of contradictory conclusions are available. A year ago the pro-RU-486 Population Council released a study based on clinical trials involving over 2,000 American women. Eighty-eight percent said they'd do it again, and 96 percent would recommend it to others. Half had previously had a surgical abortion, and 77 percent of those said they preferred the chemical method.
So what effect will RU-486 have? In The New York Times Magazine, author Margaret Talbot dreams big: peace in the abortion wars. She hope that pro-lifers, stymied in their goal of picketing abortion clinics, will give in and accept RU-486.
Pro-choicers, for their part, will have to accept restrictions on later abortions, because the average American finds them loathsome. Talbot quotes political consultant Marie Bass, who worked to bring RU-486 to the U.S.: "I don't know of any country in the world where second- and third-trimester abortions are not heavily regulated." In many other nations, abortion is virtually unknown after the first trimester; but before that point there is virtually no guilt. Talbot's dream is that this will come about in America, and that early-acting, privately dispensed RU-486 is the "magic pill" to make it come true.
The weak link, of course, is the hope that pro-lifers will accede to the popular notion that abortion is all right if it's done early. This is a combination of sentimental illogic and wishful thinking. People "just know" that the unborn isn't really "one of us," just as people in the town where I grew up "just knew" that blacks weren't really "one of us." It's natural for those in power to exclude from the community ones who look different. It's natural, but it's not right.
RU-486 won't create peace in the abortion wars; making it earlier doesn't make it better, because violence is wrong at any point of the continuum, not just when somebody is cuddly-looking. This is the conviction that energizes the pro-life movement, for almost 30 years past and as many as necessary ahead.
RU-486 is not a disaster for the pro-life movement. In fact, it may be a Trojan Horse, prompting rethinking of abortion overall.