Women's groups fought for years for the approval of the abortion pill known as RU486, which had long been safely used in Europe. A year ago this month, the FDA approved it. But in the months since that landmark decision, women's groups have confronted a more complicated issue: just because the abortion pill is legal, doesn't mean it is widely available.
RU486 is taken in two doses, inducing a miscarriage. It has varying degrees of side effects, ranging from headaches, to dizziness, to uterine hemorrhages. But while this pill will never be mistaken for Tylenol, there is no question it can make abortion more accessible -- and safer.
First, the introduction of RU486 drastically increases the number of available abortion providers by opening the field to physicians who are not necessarily trained to perform surgical abortions. (Though all physicians who prescribe the pill must have a plan in case of an incomplete abortion or health complications.) Second, the fact that RU486 allows women to terminate a pregnancy without submitting to a surgical abortion makes it psychologically easier for some women. As a result, women who want abortions may get them earlier in their pregnancies. Since later-term abortions are more dangerous than those in the first weeks of pregnancy, RU486 may contribute to women's overall safety.
College women may just be an ideal demographic for the use of RU486, according to Elizabeth Cavendish, the National Reproductive Rights and Abortion League's (NARAL) legal director. For starters, college women are more educated and younger than the general population, making them more willing to try the new pill. Cavendish also points out that these women want control over their lives and RU486 allows them that kind of control. But campuses are proving to be a case study in the problems that the controversial pill will face on the road to acceptance.
Soon after the FDA approved RU486, Yale University decided to offer the pill. But Yale is the exception. Last year, the University of New Hampshire announced that it would not be offering RU486, citing FDA regulations and the inability to deal with the possible side effects. School administrators stressed that their medical facilities are simply unequipped to deal with hemorrhages and incomplete abortions.
At Michigan State University, members of the student government have staged protests in order to bring RU486 to campus. While both the students and the health center are currently looking for a compromise, the possibility of RU486 at Michigan State seems unlikely.
Joining UNH and Michigan State in this decision are Brown University, Princeton University and Harvard University, among others. Each cites inadequate health centers.
Dr. James Trussell, associate dean of the Woodrow Wilson School of Public and International Affairs at Princeton University, argues that unlike most universities, it is more reasonable for Yale to offer the pill because of its on-campus hospital.
"I am really amazed that anybody thought that colleges would (offer RU486)," says Trussell, who sits on NARAL's board. Why would college campuses that do not offer surgical abortions suddenly offer RU486?
Advocates argue that universities that formerly were unable to provide abortions due to a lack of surgical facilities should embrace RU486 as an opportunity to offer students this safer and less upsetting procedure. There is no reason why a gynecologist working at a university health center cannot prescribe this pill. The FDA does not ask those who prescribe RU486 to monitor the woman taking the pill, and the guidelines only ask that the woman return two weeks later for an examination and that the physician make plans so that women who need emergency care can get it. Every campus has a health center, and a majority of them provide some sort of gynecological service to women. These same centers are in constant contact with outside physicians and surgeons, in many cases providing referrals and even transportation to local hospitals in cases of emergency.
Some universities that do have the medical facilities have also opted not to provide RU486. Georgetown University has a hospital and provides extensive counseling and health services to pregnant women. But a member of the Women's Health Resource Center quickly pointed out, "We are a Catholic university," when asked about RU486.
But why would non-religious universities with hospitals -- such as Harvard -- not offer the pill?
"I think it's a way to avoid a controversial message," says Eleanor Smeal, president of the Feminist Majority Foundation. Smeal's group works to increase abortion awareness on college campuses throughout the country through a program called Campus Choices, and runs a campaign on RU486 research. Smeal says RU486 is a safe and effective alternative to surgical abortion, and sees few medical complications as a result of its availability on college campuses. "This is not a hard procedure. . . Every doctor has a referring surgeon," she explains.
Increasingly, however, this is not the message being sent to doctors and the rest of the public by both state and federal governments. According to an annual report issued by NARAL, state governments are continuing to tighten controls over abortion by creating a number of laws, or what Trussell refers to as "nuisance regulations."
Pennsylvania and Michigan have both adjusted the guidelines for the use of RU486. The Pennsylvania Department of Health took the controls set forth by the FDA to a stricter level, stating that under its Abortion Control Act only facilities that provide surgical abortions can legally offer RU486. The Attorney General of Michigan, Jennifer Granholm issued an opinion in March that re-classified RU486 from its previous category as a contraceptive into the same category as a surgical abortion.
Worse still, one of the biggest opponents of RU486 has taken on the position of Director of the Department of Health and Human Services for the Bush Administration; Tommy G. Thompson has announced plans to launch a new review of the safety of RU486. Calling the drug's approval "contentious" and "controversial," Thompson has already held a hearing to discuss its safety.
Since the Bush Administration is on record as opposing abortion, such a reevaluation could result in increased restrictions.
Colleges have refused to offer RU486 because of a mix of political uncertainty and a clever misinterpretation of FDA guidelines. Now college campuses -- commonly thought of as the most progressive places in the country -- are telling students to make their choices elsewhere.
The purpose of this little pill is to provide an alternative and make abortion more accessible. It would be a terrible shame if colleges helped stomp out medical progress, and the long battle to bring RU486 to America was fought in vain.
