Chemical abortion - Interim, January 2001

January 2001

Chemical warfare against the unborn

As the worldwide push for the "morning-after pill" and RU-486 increases, pro-lifers wonder about its effect on the abortion debate and on the pharmacy profession

By Paul Tuns
The Interim

In the past few years chemical abortion has become more prevalent as country after country approved the morning-after pill (MAP) and the abortion pill RU-486.

The most infamous of these was the September 28, 2000 United States Federal Drug Administration (FDA) approval of the abortion pill RU-486 (also known as mifepristone and to be sold under the brand name Mifeprex) for abortions up to 49 days after the first missed menstrual period. Hailed as safer, less intrusive and less traumatic than surgical abortion, abortion advocates cheered the decision as a victory for women's reproductive rights. Planned Parenthood claims "it is a completely noninvasive procedure" and that because of its alleged benefits that "early surgical abortion as practiced today will be chosen less frequently among eligible women."

Pro-lifers complain that RU-486 was approved after it was put in an special accelerated category of drugs intended to make them available to dying patients and which by-passes usual safety concerns. According to the FDA's own guidelines, such accelerated track approvals "must provide meaningful or therapeutic benefits over existing treatments."

But it wasn't the process as much as the result that bothered pro-lifers. Retiring Oklahoma Congressman Tom Coburn said "Never before has the FDA approved a drug intended to kill people." Pro-lifers say whether an abortion is procured by a pill or surgery the end result is the same - a dead baby.

Concerted effort

It seems that hardly a week goes by without some new country approving either the MAP or RU-486 - in the days before this article was written Taiwan and Barbados joined the chemical abortion club, so to speak. As Cristina Alarcon, a Vancouver pharmacist and founder of B.C. Pharmacists for Conscience, told The Interim, following a lull in acceptance for chemical abortion in the mid 1990s there seems to be a concerted effort to get the morning-after pill and RU-486 approved in every country.

RU-486 was first approved for use in September 1988 in France, where it was developed by Roussel-Uclaf. By October the company suspended distribution following protests by pro-life activists, but within two days the French government ordered the company to resume distribution of the human pesticide "in the interests of public health." By 1991 it was approved in the U.K. and later other parts of Europe and China.

Pro-abortionists have been pushing for the abortion pill in North America for more than a decade. In 1998, Health Canada, at the urging of British Columbia Health Minister Penny Priddy, wrote Exelgyn, the French company which now owns the rights to RU-486, effectively encouraging the company to seek approval for its drug in Canada. While promising to be "fair" in the approval process, the unprecedented move encouraging a company to seek approval indicated the process would be anything but fair.

RU-486 is currently being tested by abortionists in four Canadian cities but no information is being made public until the "study" is completed, which is not expected for a least another year or so.

The FDA approved it last September, and although abortionists were hoping to use it immediately it was still not available in many states by year's end. Furthermore, many doctors, especially at clinics on university campuses, have not shown any interest in using it as a method of abortion.

When the FDA approved RU-486 it restricted the doctors who could use it. Pro-lifers ask, If RU-486 is as safe as advocates claim, why did the FDA require so many regulations? This "simpler procedure" requires at least three trips to the doctor and will sometimes still require a surgical abortion to complete. The FDA mandated several restrictions including the stipulation that the pill can be prescribed only by doctors trained to diagnose the stage of pregnancy and that it be used only by doctors who can perform emergency operations in case of serious bleeding or a surgical abortion if the drug regimen fails (about one in 20 women who use RU-486 will still require a surgical abortion to complete the process). Although it ultimately decided against further restrictions due to pressure from pro-abortion groups, the FDA considered restricting prescriptions to doctors who have admitting privileges at a hospital within one hour of their offices or those skilled in the use of obstetrical ultrasound. But as Americans United for Life said, "The FDA's conditions for approval are only recommendations; they are not requirements."

There has also been a push to approve MAPs and to make them widely available. But the MAP is really nothing new - prior to approval of Plan B and Preven, many doctors used the Yuzpe regimen - two high dose oral contraceptives containing estrogen and progestin - as a form of "emergency contraception."

Since 1998, both Canada and the U.S. have approved both Plan B and Preven. Preven became available in Canada in September 1999, Plan B in December 2000. Advocates claim that it is not abortifacient because it works "mainly by preventing ovulation or fertilization," although it "may inhibit implantation."

Advocates incorrectly call MAPs emergency or postcoital contraception and deny it is abortifacient. Planned Parenthood of Canada's website says they "work primarily by preventing ovulation," and "therefore do not cause an abortion." According to Gynetics Inc., the U.S. producer of Preven, "The regimen utilizes special doses of regular birth control pills, which act before pregnancy begins and will not affect an existing pregnancy." The company claims Preven, a set of four high dose birth control pills containing both progestin and estrogen, has three working mechanisms - preventing or delaying ovulation, preventing fertilization of an egg, and sometimes by making the lining of the uterus inhospitable and thus preventing implantation of a fertilized egg. It is when it prevents implantation that it is abortifacient. Still abortionists will not admit MAPs are abortifacient.

MAP advocates depend on a changed but incorrect definition of pregnancy. It is a biological fact that pregnancy (the new life) begins at fertilization (conception), but abortionists have conveniently redefined pregnancy as beginning at implantation. Michael Izzotti, co-ordinator of Pharmacists for Life International (Canada), told The Interim medical textbooks and professional associations began to change the definition of when pregnancy begins in the 1960s, and were motivated not by science but pro-abortion politics.

Dangerous to women

Despite the fact these abortifacients kill children, pro-lifers are also the only ones raising the issue about the harmful effects of such drugs on women.

Jakki Jeffs, executive director of Alliance for Life (Ontario), told The Interim that while feminist and pro-abortion groups claim to care for women and "reproductive health," their disregard for studies that show MAPs and RU-486 to be harmful to women and possibly their future fertility shows that such groups care more about abortion than they do women.

The high dose pills used in the MAP regimen are linked to increased likelihood of strokes and life-threatening blood clots and possibly certain types of cancer. Recall that they were dangerous enough to pulled off the market a generation ago. Jeffs raised concerns that using four such pills in two days has never been tested. "We don't know what the long-term health effects will be or how this will affect women's future fertility."

Nor has RU-486 been adequately tested, at least not by the FDA. Dr. Beverly Winikoff from the Population Council informed the FDA that clinical trials excluded girls under 18 although they may use RU-486 now that it is approved (in most states only with parental consent as existing abortion laws will apply).

Advocates claim RU-486 is safe but according to a 1998 New England Journal of Medicine report most women in the test cases were not followed after 15 days. Therefore, the long-term effects were not studied in the U.S. But the harmful effects are known even if abortionists won't admit them. According to the Canadian Pharmacists Association, RU-486 is not safe for women over 35, heavy smokers or women with cardiac conditions, bleeding disorders, anaemia, asthma, or hypertension, or women on long courses of corticosteroids or with adrenal insufficiency. The clinical trials in the U.S. revealed a risk of life-threatening uterine bleeding. Medical experts suggest that because of the chance of severe hemorrhaging, blood transfusion equipment should be on hand as should resuscitation equipment in the event of cardiac arrest.

During the controlled trial prior to approval, one in 100 women using RU-486 required hospitalization, and two per cent required surgery for severe hemorrhaging. The FDA's decision relied on testing done by abortion clinics which may have not reported complications. The November/December 2000 Family Voice reports that an Iowa emergency room physician contacted the clinical trial at Planned Parenthood in Des Moines to inform them that he treated a woman in shock from severe blood loss after she told him she was a part of clinical tests. But the trial's final report claimed no complications were reported among the 238 women in that particular study.

Furthermore, the FDA ignored those who did raise concerns about the safety of RU-486. In 1995, medical experts and scientists submitted a 64-page study documenting the medical dangers of RU-486 but the FDA never responded.

Of the dangerous side-effects, abortionists seem quite unconcerned, at best. In 1999, Suzanne Poppema, President of the National Abortion Federation and a Seattle abortionist who tested RU-486, said, "Having a group of women doing a lot of bleeding and cramping in your office, when they would rather be home, racing to the bathroom when they need to go to the bathroom ... [who] were not only having bleeding but they were also having diarrhea, doesn't do much for the [patient] flow in your clinic." She said women should go home where they can be comfortable, but her comments show a complete disregard for the safety of women over the commercial interests of abortionists.

This danger is recognized by the Canadian Pharmacists Association in their original drug brief on RU-486, which warned that "Because there are some risks with the regimen you must ensure that you are closely monitored by a physician. It would be dangerous to take it at home on your own."

Another danger with the abortion cocktail is that one of the two drugs, misoprostol (which goes by the product name Cytotec in the U.S.) has not been approved for such use by its manufacturer, Searle Pharmaceuticals. On August 23, 2000 Searle wrote the FDA and The American College of Obstetricians and Gynecologists to say the drug should not be used to induce labour or abortion, warning misoprostol (normally used to treat ulcers) could cause uterine rupture, severe vaginal bleeding, shock and "fetal or maternal death."

Aside from the physical dangers, there are also psychological consequences. Edouard Sakiz, then-chairman and CEO of Roussel Uclaf, the original manufacturer of RU-486, told the August 19, 1990 Le Monde that "As abortifacient procedures go, RU-486 is not at all easy to use. In fact it is much more complex to use than the technique of vacuum extraction. True, no anaesthetic is required. But a woman who wants to end her pregnancy has to live with her abortion for at least a week using this technique. It's an appalling psychological ordeal."

Jeffs said women will have to deal with the long-term psychological affects that they were the ones who had their babies killed, a fact more real considering it is not uncommon for the fetus to be "flushed from the body" (in the words of one RU-486 booster) outside the confines of the doctor's office. Jeffs said when women realize what it is, there will be an incredible psychological toll and they will not have the distance from the act of abortion that the doctor provides in a surgical abortion.

There is also a danger to the unborn child if it survives the chemical abortion. In 1996, Dr. Wayne Bardin of the Population Council said only 21 women changed their minds after beginning the RU-486 regime and that three children (or one in seven) suffered congenital abnormalities or died. The number of women who change their mind is likely to increase as more countries approve RU-486. Izzotti raised concerns that RU-486's drawn-out process could lead women to change their minds or not complete the drug regime for some other reason leading to increased numbers of harmed and doomed newborns. Bardin admitted that the animal testing shows a high rate of congenital abnormalities when RU-486 is not completed.

Despite these dangers, with the approval of RU-486, this dangerous drug is, as Barbara Asbell put it in The Pill: A Biography of the Drug that Changed the World, "likely to become the preferred morning-after pill." Advocates hope RU-486 will make abortion more private and widespread. Last year, Poppema said she hopes RU-486 "will mainstream abortion into regular medical care."

Effect on the abortion debate

The Feminist Majo rity Foundation predicts half of all American abortions will eventually be procured by RU-486. Assuming current rates, that would translate into 650,000 chemical abortions in the U.S. per year. CARAL claims the drug could eliminate 30,000 first-trimester abortions in Canada. But Izzotti said all that changes is the method of abortion. Jeffs said at the very least rates would remain the same but she worries that selling abortion as a simple and safe procedure might reverse the recent trend that saw the number of officially counted abortions decline. Both Izzotti and Jeffs said the abortion numbers do not include the countless unborn children aborted by the MAP.

Jeffs said pro-lifers must insist on maintaining accurate statistics on the number of chemical abortions and the demographics of women using them. She said society must not allow itself into being lured into accepting more abortion simply because it will in the future increasingly depend on using a pill instead of surgery.

The biggest change RU-486 will affect is to make abortion more private. Planned Parenthood says it "may offer women more privacy in the abortion decision, along with greater personal control over the process of pregnancy termination." This will have ramifications on the abortion debate. The November 5, 2000 Washington Post said, "Pro-choice advocates say RU-486 will change the nature of the abortion wars. Women will be able to terminate an early pregnancy in their doctor's office or at home, making abortion everywhere and nowhere." While some advocates believe (in the words of the Post) "women will be able to bypass the public theater of abortion," the same article notes how the Florida abortuary profiled does not believe the demonstrations will stop.

As reported earlier, many doctors and clinics are not ready to use RU-486 despite a 1998 poll by the Henry J. Kaiser Family Foundation of family practitioners about their interest in using RU-486 once it was approved and available: 45 per cent of doctors responding said they were "very" or "somewhat" likely to use it - even though only three per cent of them had performed surgical abortions. Jeffs said this may indicate that at least for now RU-486 may not make abortion more widespread.

But the biggest change in the debate is not the availability or the presence of demonstrators outside abortuaries. The biggest change is how it will affect society and abortion-minded women think about abortion.

In the October 2, 2000 National Review Online, social critic Midge Decter said, "One thing above all distinguishes a pill from a curette: It is infinitely more abstract and immaterial." This will have profound effects on the abortion debate. Even though the end result is the same (an aborted baby) Decter said popping a pill that results in heavy bleeding and nausea would be preferable for many women over surgery because "it can feel like something that is happening to one rather than something one is doing." Decter said it is only natural that many women are, at least momentarily, "haunted by the thought of the baby who never was and her part in making that so." Decter said pro-abortionists want woman "to go through this experience without some deep consequence."

By having those seeking abortions believe RU-486 is simpler, safer, more private and personally controllable, abortionists have sold women a bill of goods for the sake of the pro-abortion agenda. Whatever other "benefits" there might be to RU-486 - Decter identifies getting around parental consent more easily, avoiding anti-abortion demonstrators, the appeal of popping a pill over surgery - abortionists will have succeeded in having women "set the deed in motion without having to be nearly so mindful of what one is actually doing."

For abortion supporters, chemical abortion also has the advantage of killing the unborn child even earlier, making it easier to dehumanize the child. Izzotti said, "promoters of the morning-after pill are dehumanizing the newly created human being in the same way that they tried to dehumanize the fetus. Only now it is much smaller and you can't see its similarities to us - i.e., it doesn't look like a human being at that stage. However, it looks exactly like a human should look at that stage of development and we all looked like this at one time. Now instead of fetus, it is called zygote and embryo." Izzotti said the dehumanizing of the unborn child makes it easier not only for women to make the tragic choice of abortion but for health care professionals to be involved in the killing of what many of them believe to be nothing more than a "blob of cells."

Jeffs recognizes that the growth of chemical abortion will affect the tactics of pro-lifers but she insisted there will always be room for activism. "The way we are active might change but we are always going to stand up for life," she said.

Jeffs said pro-lifers will still demonstrate but that the target of their protest might not be the abortuary but the pharmaceutical companies. She urged pro-lifers to join the demonstration at Roberts Pharmaceuticals, Canadian producers of Preven, in Oakville, Ontario every Friday.

She also said there will be more letter writing to health care professionals, their organizations, drug companies and politicians to inform them about the abortifacient nature of these products. "Many people do not realize the morning-after pill often kills an unborn child." Furthermore, she said pro-lifers must educate the public about the humanity of the child from the moment of conception (defined properly as the fertilization of the egg by the sperm). She said the pro-abortionists cannot be allowed to prevail because they won the debate on semantics.

Such public education should begin immediately. Izzotti said pro-lifers should use March 5-11, Pharmacists Week, as an opportunity to engage their pharmacists, which he said are the under-appreciated cogs in the health care machine. He said asking pharmacists how the MAP works and whether or not it is abortifacient will indicate the public cares about the issue and perhaps educate the pharmacist. Izzotti added that is important to ask to see documentary proof, thereby ensuring the pharmacist carefully considers the issue and doesn't just give the public the company line.

Chemical abortions will become more prevalent in the years to come. Pro-lifers must be prepared for the inevitable changes in the abortion debate or face a future where abortion will become an even more accepted and common occurrence.

How Abortifacients Function

PLAN B
The Plan B package consists of two 0.75 mg tablets of levonorgestrel. The first pill needs to be taken within 72 hours of "unprotected" sex and the second pill is taken 12 hours later. Levonorgestrel is a synthetic hormone used in more than 80 brands of daily birth control pills since 1968. Advocates claim it reduces the "risk of pregnancy following a single act of unprotected sex" by 89 per cent. Plan B often works to prevent ovulation or fertilization by altering tubal transport of sperm and/or ova but often acts as an abortifacient by altering the endometrium and inhibiting implantation.

RU-486
The abortion pill RU-486 is actually a two-pill regime. Mifepristone causes a miscarriage by blocking the hormone progesterone, which is needed to maintain a pregnancy. Mifepristone weakens the endometrium so the embryo cannot implant in the uterus. Mifepristone is followed 48 hours later by a second drug, misoprostol (a prostaglandin), which forces the uterus to contract. The fetus is expelled later, from a couple hours to a few weeks. When taken within 49 days of the last period, the two-drug combination is 95 per cent effective. Advocates say one of the benefits of RU-486 is that it can be used earlier than surgical abortion.
'Morning-after pill' Campaign in Canada

Not only are pro-abortionists trying to have MAPs approved, they are pushing to have easier access to them, usually through taking the doctor out of the equation and allowing over-the-counter sales (although sometimes they want to grant pharmacists the right to prescribe MAPs themselves and to contact doctors after the fact). On December 5, 2000, the American Medical Association's House of Delegates approved a recommendation requesting the FDA consider making "emergency contraception" available over-the-counter.

While even Planned Parenthood warns against using MAPs routinely, the plan to have pharmacists dispense the drug will decrease the ability to track usage. Alarcon said pharmacists do not have the training, time or kind of relationship with a patient that doctors do to properly counsel women seeking the MAP, including knowing the patient's medical history. She also said requests for the MAP can indicate other issues doctors can watch out for such as sexually transmitted disease or abuse that over-the-counter distribution would not catch.

Aside from the usual suspects of Planned Parenthood and the Canadian Abortion Rights Action League, the push for over-the-counter MAPs comes from the Canadian Pharmacists Association (CPhA), the provincial colleges of pharmacists, and the Society of Obstetricians and Gynaecologists of Canada (SOGC) in Canada and the World Health Organization internationally. The first Canadian breakthrough was in British Columbia under the NDP government.

After almost a year of debate and postponements, the B.C. government announced in October 2000 it would revitalize a plan to have MAPs dispensed by pharmacists without the benefit of a doctor's prescription beginning December 1. Alarcon said there was no public clamour for the move, that it was a political move by B.C. Premier Ujjal Dosanjh. The policy change was expected to ignite a flurry of calls for similar moves across the country and indeed in November, the Ontario Medical Association passed a resolution calling for over-the-counter sales. Canadian abortion pioneer Henry Morgentaler made a similar plea.

In an November 1, 2000 letter to Ontario Health Minister Elizabeth Witmer, Morgentaler urged the province to allow pharmacists to dispense MAPs without a doctor's prescription. Morgentaler said MAPs are "ordinary birth control pills that significantly decrease a woman's chances of becoming pregnant when taken within seventy-two hours of unprotected sex." Using the term "ordinary birth control pills" ignores the fact they are actually similar to the higher dose birth control pills yanked off the shelves in the early 1970s after they were shown to be linked to cancer, strokes and other complications. Therefore, Morgentaler is wrong when he says "numerous studies" show it to be "absolutely safe."

Morgentaler, like most "emergency contraception" advocates, claim MAPs should be more "accessible to a woman facing a broken condom on Friday night when a doctor's office is closed for the weekend, a woman in a rural area who can't easily get the prescription or a teenager who is afraid to talk to her doctor about family planning." But Alarcon said women may resort to MAPs as a regular form of birth control.

Morgentaler may not have to wait long to get his wish because last year the taxpayer-funded Ontario Women's Health Council announced that it would begin a pilot project in September 2001 allowing women to get MAPs without a doctor's prescription. However, the objectivity of such a study can be questioned when one considers that their website lists among its objectives "making emergency contraception available without a prescription" and "improving abortion services and access across Ontario."

Over-the-counter plans pose another threat to conscience rights

The move in B.C. to have pharmacists dispense MAPs in lieu of a doctor's prescription has renewed calls for professional and legislative protection for the conscience rights of health care workers.

Sean Murphy, administrator for Protection of Conscience Project, told The Interim, "There is a strong tendency of professional associations, state organizations and institutions, licensing bodies and the government to force people to get involved in matters that violate their conscience." He said conscientious objectors are usually a minority within a profession and therefore are seen as easy to pressure or harass. He said conscience protection is necessary considering the issues health care workers are expecting to deal with in the upcoming years: doctor-assisted suicide, euthanasia, cloning, genetic manipulation, and possibly even capital punishment, as the March/April 2000 College of Pharmacists Bulletin notes.

Murphy said considering the range of issues and professions that must be addressed, legislated conscience protection is preferable to professional associations dealing with each issue one-by-one.

The College of Pharmacists British Columbia Code of Ethics says "A pharmacist is not ethically obliged to provide requested pharmacy care when compliance would involve a violation of his or her moral beliefs. When that request falls within recognized forms of pharmacy care, however, there is a professional obligation to refer the patient to a pharmacist who is willing to provide the service. The pharmacist shall provide the requested pharmacy care if there is no other pharmacist within a reasonable distance or available within a reasonable time willing to provide the service." This is similar to the code of ethics and professional guidelines of most pharmacy colleges and professional associations, with the exception of the Manitoba College of Pharmacists which does not require pharmacists to refer patients elsewhere.

Alarcon said forcing pharmacists to refer patients is wrong. She said referring a client to another pharmacist in order to help kill a baby "turns the referring pharmacist into an accomplice."

The B.C. Code of Ethics also calls for pharmacists to assist "patients to make informed choices about their own best interests." Yet Alarcon reports pharmacists who inform clients about the abortifacient nature of MAPs are said to be imposing their pro-life beliefs. The March/April 2000 College of Pharmacists Bulletin even warns that providing information about the possible effects of treatments pharmacists object to morally might be a "guise [for] patient counselling" to accept the pharmacist's position.

Alarcon reports about 100 B.C. pharmacists will refuse to dispense MAPs or refer clients to someone who will. The November 23, 2000 Vancouver Province reports that Brenda Osmond, the deputy registrar of the College of Pharmacists of B.C., said pharmacists can refuse to dispense a drug but they must refer the client to someone to fill the prescription, and "if there is no one else the patient's rights must be honoured and the pharmacist must provide the drug."

Murphy said when the rights of the client to a treatment they want and the conscience rights of a pharmacist clash, there is no reason why the rights of the patient should automatically be paramount. And Maria Bizecki, spokesperson for Concerned Pharmacists for Conscience, told The Interim that one pharmacist refusing to dispense the MAP will not prevent a patient from going elsewhere to get it. MAP advocates, Bizecki said, "want access as easy and convenient as possible - it doesn't matter about the rights of pharmacists."

Bizecki said there is room to accommodate the conscience rights of pharmacists. While the College of Pharmacists of B.C. exists to protect consumers, the B.C. Pharmacy Association exists to represent pharmacists. Bizecki said the association "is being combative." She noted eight of 10 Canadian Medical Association provincial chapters do not force doctors to perform abortions or refer patients to doctors who do. "Why don't pharmacists have the same rights?" she asked.

She said protecting conscience rights of pharmacists is not at all a concern for the provincial colleges of pharmacists that license the profession or the associations that represent them. "There is total freedom for women who want easier access to pills that kill their children but no freedom for pharmacists."

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