Abortion Pill Raises Questions As It Provides Solutions

      As much anticipated as Mifeprex, the abortion pill, is, doctors seem just as anxious to get their hands on an instruction manual.

      After extensive testing in Europe and through clinical trials in the United States, the drug was approved by the Food and Drug Administration in September and should be available to doctors in November. While doctors say they know how the pill works medically, still to be worked out are details. How much will it cost? What kind of counseling should accompany its use? Will state or federal regulations governing abortion clarify or cloud the already murky picture?

      ``The questions are more about what protocol will become common practice,'' says Dr. Stanley Henshaw, a sociologist and senior fellow with the Alan Guttmacher Institute, which tracks abortion data. ``There''s a learning curve for doctors.''

      Doctors will be able to start prescribing Mifeprex -- known as RU-486 in France, the early option or abortion pill -- in the next few weeks (no specific rollout date has been set). A two-dose regimen of Mifeprex (the manufacturer''s name for mifepristone) and a second drug, misoprostol, allows women to terminate a pregnancy up to the seventh week after conception without a surgical procedure.

      Referred to as a medical (as opposed to surgical) abortion, the pills will be dispensed in a physician''s office, where a woman will sign a consent form agreeing to end her pregnancy and take the medication. At home she''ll basically endure the equivalent of a planned miscarriage. The regimen requires three doctor''s visits. Side effects include bleeding, cramping and possibly nausea, headaches and diarrhea.

      Don''t look for a repeat of doctors freely and openly dispensing the abortion pill as they did with Viagra. Mifeprex figures to enter the marketplace quietly, with few private-practice doctors advertising its availability. Women seeking a doctor to prescribe Mifeprex will probably go through the same channels they used to find a doctor willing to perform a surgical abortion -- Planned Parenthood and referrals from family physicians or the National Abortion Federation.

      A survey of more than 750 doctors conducted in April by the Henry J. Kaiser Family Foundation revealed that 44 percent of gynecologists and 31 percent of family physicians surveyed would be interested in prescribing Mifeprex to their patients. In addition, 31 percent of gynecologists who were not currently providers or who had never performed an abortion said they would consider prescribing Mifeprex.

      Extra responsibilities could keep physicians who didn''t perform surgical abortions from prescribing Mifeprex. In addition to being current on all state regulations, providers have to be able to perform a surgical abortion -- or make one available -- if the Mifeprex/misoprostol regimen isn''t successful. Some state regulations require abortion providers to increase their office space, provide beds and even hire additional staff.

      ``A lot of physicians have never had any experience thinking about these issues,'' said Tina Hoff, director of public health information and communication for the Kaiser Family Foundation. ``Other factors inhibit the medication''s use beyond a physician''s interest in using it.''

      California is one of eight states that requires patients seeking an abortion to obtain state-directed counseling before undergoing the procedure, a mandate that will apply to medical and surgical abortions. Unlike other states, California law does not mandate a waiting period between consultation and the procedure. Thus abortion ``counseling'' is often limited to a description of the medical procedure.

      ``Counseling and education are highly correlated with satisfaction in all abortion care, but it''s particularly true of RU-486,'' said Dr. Miriam Cotler, a professor of medical ethics at California State University, Northridge. ``Who will do the counseling? How will it be done? What sort of follow-up or monitoring will there be?''

      Abortion-rights activists believe a thorough briefing on the procedure, including how the abortion will be carried out and what sorts of side effects a woman can expect along the way, is all that''s necessary.

      ``In California, state law does not treat women like children,'' says Deni Robey, spokeswoman for Planned Parenthood Los Angeles. ``It knows some women are clear about this decision without needing a lecture.''

      Officials from anti-abortion organizations disagree.

      ``They need to know about fetal development, about the short-term and long-term side effects and possible psychological consequences, and they need to know that meaningful alternatives are readily available, that there are caring people ready to help them every step of the way,'' says Jenny Biondi, spokeswoman for the Right to Life League of Southern California, which operates crisis pregnancy centers and maternity homes.

      And she is concerned the counseling element might be overlooked or ignored by women seeking a medical abortion.

      ``Abortion is a decision women make in fear and panic. The idea that they can just swallow some pills appeals to women. This doesn''t give them a chance to weigh their options.''

      At Planned Parenthood, a woman seeking a medical abortion will first undergo ultrasound to verify the pregnancy and determine whether she is within the 49 days since her last period as required by the FDA. A woman who wishes to proceed will review the procedure with a doctor or nurse practitioner -- including potential side effects and the necessity of having a surgical abortion if the regimen fails. After signing a consent form, she can take the medication in the office.

      Activists and doctors might also take special interest in the outcome of the November election, which could determine whether legislation will enter the picture.

      ``It''s an open question over whether anyone from Congress will pursue restrictions over and above what the FDA has already imposed,'' said Caitlin Borgmann, state strategies coordinator for the American Civil Liberties Union Foundation''s Reproductive Freedom Project. She doesn''t expect legislators to pursue further regulations. ``I think it isn''t really the best target for anti-abortion advocates to be taking up.''

      State regulations are another matter, said Borgmann, though residents of California -- a state with few restrictions on abortions -- probably need not expect challenges to existing laws that would make medical abortions more difficult to obtain than a surgical abortion.

c. 2000 Los Angeles Daily News