Surgical abortion is legal, why not medical abortion?
by Vera Monday January 30, 2006 at 01:59 AM

A leading medical researcher in reproductive health has expressed concern at the level of misinformation and emotive aguments against the use of RU486 for medical abortion.

"I am extremely concerned about a number of statements made regarding the use of Mifepristone RU486 for medical abortion which are both incorrect and presented in an emotive manner without relevant references to the research", said Dr Weisberg.

Dr Edith Weisberg, AM is a world renowned sexual and reproductive health researcher and Director of Research, Sydney Centre for Reproductive Health Research. She has coordinated Australia’s major research work on Mifepristone and is one of Australia’s best informed on its use.

The Senate inquiry has received a record number of submissions regarding the ban on RU486. Pro-life campaigners have been active in an emotive campaign against lifting the restrictions. Getup! has also launched a campaign to Get Politics out of Medicine, making use of Mifepristine (RU486) a personal and medical decision between the treating doctor and the patient.

According to the Family Planning Association, Mifepristone and other abortifacients are the only drugs requiring the approval of the Minister for Health to be used in Australia. Mifepristone is used extensively in Europe (including Italy), the USA and the UK but is effectively banned in Australia.

Mifepristone RU486 also has other clinical uses. Richard C Henshaw, Obstetrician and Gynaecologist at Queen Elizabeth Hospital in South Australia, said in a MJA article (1997) "It has been used to shorten the process and reduce analgesia requirements in labour induction in cases of second-trimester and third-trimester abnormal pregnancy or intrauterine fetal death. Medical uterine evacuation in first-trimester miscarriage is also being explored."

A 1994 study conducted by Monash University and Family Planning Victoria with 38 participants in a World Health Organization-sponsored trial said:

Satisfaction with medical termination of pregnancy among the 38 women was evident. The factors involved in their choice of medical abortion were complex. Overall, medical abortion provided women with a more active role in the process, thus allowing them to achieve a certain degree of autonomy. Most of the women surveyed described the medical approach as more natural, and two women likened the procedure to having a miscarriage.

Mifepristone was restricted for import after a controversial amendment was passed in 1996 when Senator Harradine argued that the drug should be made illegal. Liberals in the Howard Government supported the amendment in return for Harradine's support for the initial sale of Telstra shares. Support was also given to the amendment by the ALP.

Dr Edith Weisberg described the procedure and effectiveness of medical termination of pregnancy:

"Since the first clinical trials of medical abortion were instituted in 1982 in France there has been on going collection of data. The dose of mifepristone has been reduced from the original dose of 600mg (3 tablets) to 200mg(a single tablet), which is followed 1-3 days later by prostaglandin given either orally or inserted into the vagina1. This procedure results in complete abortion in at least 95% of cases up to 9 weeks of pregnancy and 94% of abortions carried out between 9-13 weeks. In the small number of cases where medical abortion is unsuccessful surgical evacuation of the uterus is carried out by the same procedure as used for surgical abortion. There is evidence that the frequency of surgical evacuation decreases as the experience of the clinical team with medical abortion increases. In data derived from large cohort studies of women undergoing surgical abortion the need for a second procedure due to incomplete evacuation of the uterus are reported at around 1%"

Sexual Health & Family Planning Australia has produced the following fact sheet, released in January 2006:

The Facts - Mifepristone/RU 486 - Abortion

35 Countries use Mifepristone
Mifepristone is widely used and has been approved by 35 countries including the United Kingdom, France, the United States, Sweden, Greece, Spain, Tunisia and New Zealand.(1)

21 million women use it
It has been used by over 21 million women worldwide.(2)
In the US where mifepristone has been available since 2000 (for five years) there have been 530,000 medical abortions using Mifepristone.(3) 
In that time, five years, there have been four deaths from septic shock (4) 
The total number of abortions in the US in 2002 was 854,122.(5)   The number of medical abortions was 36,297 which is 4.2%. (Mifepristone is the drug used to induce medical abortion in almost all cases.)

Some interesting comparisons
In the US there were 27 deaths caused by aspirin in 2000.(6)  By contrast there were four deaths possibly related to the use of Mifepristone over five years.
(The Clostridium sordellii infection which caused the deaths is also responsible for deaths in situations unrelated to medical abortion.)

Deaths due to pregnancy
In the US in 2002 there were 357 maternal deaths.(7)

The History of Abortion in Australia
In Australia in 1965 there were 45 maternal deaths due to abortion.(8) 
There were 34 maternal deaths in Australia between 1997-99 and there were no deaths due to abortion.  (9) (This is the most recent data publicly available.)
Illegal abortions performed prior to 1971 were a major cause of maternal mortality in Australia. Illegal abortion was ranked second in the five main causes of maternal death in Australia.(10) 

Performing abortions before legality led to death and infertility
In the 1960s when abortion was illegal, abortions were performed in private rooms by people who were abortionists and not always doctors. Their medical practice was unscrutinised or ignored by the medical profession and the public. The methods were tailored to the illegality and clandestine nature of the procedure, rather than the safety of the patient. (11)

Throughout the world illegal abortions continue to kill
Current estimates indicate that 19 million unsafe abortions take place each year, mostly in the developing world. These result in some 68 000 deaths. (12) 

Legal abortion
The Netherlands, where abortion is both legal and readily available and where contraception is widely promoted and used, has the lowest abortion rate of any country in a 1999 study. (13)
In Australia around 80,000 legal abortions are performed every year. Women between 20 and 24 have the highest rate with 32.7 for every 1000 women. Teenagers have a much lower rate - 20.8 for every 1000 women up to 19 years old. (14) 
In a recent study of Swedish women nearly all the women in the study described their abortion as a relief or as a form of taking responsibility, not only immediately after the abortion but also 4 and 12 months after the abortion. (15)  Also, for the vast majority of women, legal and voluntary abortion rarely causes immediate or long-term negative emotional effects. (16)

References
(1) Gynuity Health Projects 2005, List of mifepristone approval, viewed 18 January 2006, <http://www.gynuity.org>.
(2) Public Health Association of Australia 2005, Submission from the Public Health Association of Australia to the Inquiry Into Therapeutic Goods Amendment (Repeal of Ministerial Responsibility for Approval of RU 486) Bill 2005, viewed 18 January 2006, <http://www.phaa.net.au/Advocacy_Issues/submissiontosenate2005ru486.htm>.
(3) Tanne J 2006, ‘US doctors debate safety of abortifacient drug’, British Medical Journal, Vol. 7533, pp.71.
(4) Greene M 2005, ‘Fatal infections associated with mifepristone-induced abortion’, The New England Journal of Medicine, Vol. 353 No. 22, pp. 2317-8.
(5) CDC 2005, Health, United States, 2005, National Center for Health Statistics Health, United States.
(6) Jones A 2002, ‘Over-the-counter Analgesics: A Toxicologic Perspective’, American Journal of Therapeutics, Vol 9, No. 3, pp. 245-257.
(7) CDC 2005, Health, United States, 2005, National Center for Health Statistics Health, United States.
(8) AIHW 1996, Australia's Health 1996, AIHW, Canberra.
(9) Slaytor E, Sullivan E & King J 2004, Maternal Deaths in Australia 1997–1999, AIHW, Canberra.
(10) National Health and Medical Research Council 1969, Report on maternal deaths in the Commonwealth of Australia, 1964-66, AGPS, Canberra.
(11) Royal Commission on Human Relationships 1977, Final Report Volume 3, AGPS, Canberra.
(12) World Health Organization, 2004, Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2000, WHO, Geneva.
(13) Henshaw S, Singh S & Haas T 1999, ‘The Incidence of Abortion Worldwide’, International Family Planning Perspectives, Vol 25, Supp, pp.S30–S38.
(14) Grayson N, Hargreaves J & Sullivan EA 2005, Use of routinely collected national data sets for reporting on induced abortion in Australia, AIHW National Perinatal Statistics Unit, Sydney.
(15) Kero A, Hogberg U & Lalos A 2004, ‘Wellbeing and mental growth-long - term effects of legal abortion’, Social Science And Medicine, Vol. 58, No. 12, pp. 2559-69.
(16) Bonevski B & Adams J 2001, Psychological effects of the termination of Pregnancy: A summary of
the literature 1970-2000, Newcastle Institute of Public Health, Newcastle.

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A nation-wide coalition of women’s health organisations and pro-choice groups formed in June 2005 to respond to pro-life attacks on women’s reproductive rights. "Reproductive Choice Australia is collectively taking action to protect the existing reproductive rights of women and address the many shortcomings in the law and service delivery in Australia,” said Dr Leslie Cannold, ethicist at Melbourne University’s Centre for Applied Philosophy and Public Ethics at the time of the launch.

Over 20 organisations are involved in the coalition including Sexual Health & Family Planning Australia, Children By Choice, the Public Health Association of Australia, the Australian Women’s Health Network, the Women’s Electoral Lobby, and all state based pro-choice coalitions.

Sources:

• misinformation swirls around the Senate Inquiry - 18 Jan 2006
• The Facts - Mifepristone/RU 486 - Abortion
• A response to Dr Renate Klein's comments on Mifepristone (RU486)
• Women's satisfaction with medical abortion with RU486 - Medical Journal of Australia, 1997
• Mifepristone (RU486) and abortion - Medical Journal of Australia, 1997
• Betrayal of Women on RU486 - WEL 1996
• No room at the inn for RU486 - ABC Radio The Pulse Health Matters, 18 November, 2004
• Reproductive Choice Australia
• Children by Choice on RU486
• Getup!: Get Politics out of Medicine

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