The RU-486 pill and other abortifacients: Birth control of the future?
Gonzalo Herranz, department of Bioethics, University of Navarra.
discussion paper in Primer congress Internacional por la Vida y la Familia.
Corporación Movimiento Anónimo por la Vida/Human Life International.
Pontificia Universidad Católica, Santiago, Chile.
Saturday, 20 August 1994, 10:30 am.
a. The progressive irrelevance of concepts
b. Mifepristone, the molecular bridge between contraception and abortion
2. The deliberate confusion of terminology as an instrument of psychological and moral manipulation.
3. The trivialisation of abortion, the final consequence of the contraception-abortion continuum
A few weeks ago, in the last days of June, the Socialist government in power in Spain announced its intention to send to purpose a new law on abortion to be submitted to congress de los Diputados, which would include the possibility for women to have an abortion within the first 12 weeks of gestation. It is a tradition, already practised very astutely by General Franco, to use the beginning of summer, when half the country is enjoying its summer holidays, to approve unpopular government measures or to present the most compromising legislative projects. In any case, it is no exaggeration to say that for a few days nothing else was spoken or written about in Spain: a lively public discussion of the matter broke out.
Representatives of different socio-political, legal and professional attitudes were invited to a programme on Madrid television to discuss the new law. Among the participants was a gynaecologist, sadly famous for his extremely radical attitude in favour of abortion, who had been sentenced some time ago by the Supreme Court to imprisonment for performing illegal abortions, but who was pardoned by the socialist government. In the course of the programme, this gynaecologist said that he was openly against abortion, that he no longer wished to perform abortions: that the future had begun with the employment of RU-486, not as a drug that causes abortion in the first seven weeks of pregnancy, but as a counter-medication to be taken by sexually active women as soon as they realise that their menstrual period is not coming at the expected time. The gynaecologist argued that it is infinitely cleaner, more humane, more practical, more economical and more ethically comfortable to prevent the initiation of a pregnancy by ingesting a dose of RU-486, than to resort either to a surgical or pharmacological abortion, which is always traumatic and uncomfortable, or to use a contraceptive method, be it the oral contraceptive pill, depot contraceptives, IUDs, barrier methods or natural methods.
Our gynaecologist was once again echoing the message that Dr. Emile Etienne Baulieu has been repeating for some years now when he propagates the contraceptive use of RU-486 as the birth control of the future.
But before considering the future, it is worth looking back to examine two issues: the first concerns the slide towards "abortifacient impurification" that contraceptive methods have undergone throughout history. That is, how the continuity Biochemistry , psychological, medical and moral continuity of contraception and abortion has been slowly but inexorably established.
The second is to show how even today, neither the majority of general practitioners, gynaecologists nor pharmacologists are interested in considering the distinction between contraceptive effects in the strict sense, i.e. anovulatory, and abortifacient effects of birth control methods as scientifically and ethically relevant. To arrive at such scientific and ethical indifference has required a complicit manipulation of language in order to narcotise the moral conscience and blur the classical biological taxonomy that distinguished conception as a cardinal phenomenon of reproductive physiology. The manipulation of words and the redefinition of terms has allowed some to forget the ethical and biological differences between contraception and abortion.
We will then be in a position to address our central topic : to understand how this new synthesis of contraception and abortion is planned for the future with the introduction of antiprogesterones, the pills capable of acting as contraceptives and also of inducing abortion. And how the contraception-abortion continuum is definitively established on the biochemical, medical, psychological and moral levels. The future, according to Baulieu, is the era, not of contraception, but of counter-management.
1. Looking back 
Indeed, in the field of contraception there has been a consistent, almost inexorable historical evolution that is interesting to know, because it is not only a history of how molecules, doses, routes of administration, unwanted effects or clinical trials have evolved, but it is above all the history of how an ideology has been imposed, how ethics have been falsified, how technical and economic efficiency has drowned out important moral values.
And the story is this: the primitive design to control fertility was operated by means of anovulatory agents which, by preventing ovulation, placed the ethical conflicts in the preconceptional phase. It is obvious that there is a grave moral responsibility, formulated in a very lucid way in Humanae vitae, in blinding the sources of life and making the conjugal act artificially and deliberately infertile by means of anovulatories. But this action was not burdened with the additional guilt of destroying a human being.
But that first-generation anovulatory pill was a pharmacologically "heavy" product. The dose of hormones, especially oestrogens, needed to disrupt the maturation of the ovarian follicle each month and prevent ovulation was too high and caused many women unpleasant side effects. It became necessary to reduce the dose of hormones contained in the pill. This change had several consequences: the initial anovulatory mechanism of action was replaced by a complex new mechanism of action, combining the occasional anovulatory effect with changes in the cervical mucus, which becomes very thick, viscous and difficult for sperm to pass through, and changes in the motility of the fallopian tube, which hinders the transport of the oocyte. But above all, and in particular, there are changes in the endometrium, the inner lining of the uterus, which becomes refractory to the nesting of the embryo, in the event of fertilisation having taken place. This last factor is of great technical, human and moral significance, as it determines that the new pills, which act through different mechanisms, have a potentially abortive effect.
It is curious that we do not have much information on this aspect of contraception. There is not much research on it. It seems that the pharmaceutical laboratories that produce modern contraceptives are not very interested in determining the intensity of the abortifacient effect: it is certainly not an easy matter to study if we want to do it with great precision. But, I am convinced, the scarcity of programs of study does not come from the difficulty of its experimental design , but from the possible damage to the good reputation of the pill of leave doses of oestrogens that could be caused by the clarification that they act in 30%, 15%, or 5% of cases through an antinidatory, early abortive action.
a. The progressive irrelevance of concepts
The boundary between birth control/birth control and abortion has become progressively blurred, to the point that for many physicians and bioethicists, and also for some moral theologians, it is a question of no interest: it is a matter that can be ignored or considered irrelevant. A few years ago, there were frequent articles that still questioned the biological and moral significance of whether a certain agent acted at a preconceptional stage, preventing ovulation or impeding fertilisation, or whether it acted after fertilisation, directly injuring the young embryo or simply preventing its nesting. Journals published articles with titles such as The morning-after pill and the intrauterine device: contraceptive or abortifacient? or Mifepristone, contragestative agent or medical abortifacient? This is very much in line with the scientific vocation of medicine: it is not enough to know the final effects of biomedical interventions: it is necessary to determine and study in detail the mechanisms by which they act.
Well, articles that study these problems are a species at risk of extinction. This does not seem to be due to the fact that subject lacks scientific interest. The lack of interest in the problem comes from outside: the clarification of the mechanism of action can create a rejection of these procedures in certain religious or cultural environments. To avoid such rejection, the best thing to do is to ignore it: either to draw a veil of silence over what is already known, or to make the problem disappear by not taking any interest in it, either scientifically or ethically.
A history may shed light on this course of action. In a review article , published in a reputable journal, graduate A Decade of Intrauterine Contraception: 1976 to 1986, Howard J. Tatum and Elizabeth B. Connell, of Emory University School of Medicine, Atlanta, Georgia, relate how IUDs were cleared of any malignancy. In their words: Allegations have been made from the time IUDs began to be used for contraceptive purposes that their action is primarily abortifacient. This concept has been propagated by certain religious groups who have consequently outlawed the IUD as a morally acceptable means of fertility control.
One would expect the authors to refute these accusations in a scientific manner by providing evidence relevant to the basic question, namely whether the different types of IUDs have a preconceptional mechanism of action on the gametes themselves or whether, on the contrary, they destroy the young embryo at some point in its existence, whether before, during or after implantation in the uterine wall. But the disillusionment is immediate: the refutation of these allegations is made, not on the firm ground of scientific facts, but by means of the tactical redefinition of concepts, by what can fairly be called brainwashing.
We are misled by Tatum and Connell when they tell us: Precise definitions of the terms gestation and abortion and recent scientific data help us to reject such misconceptions and misleading information that, in the past, have clouded the whole issue of the mechanisms by which the contraceptive effect of IUDs is exerted.
There is no doubt that the new definitions are endorsed by very important corporations, perhaps more interested perhaps in dressing up their professional routines with apparent dignity than in clarifying the reality of the facts. With cynical simplicity, these new definitions ignore the morally significant part of the reality, and everything is considered fixed by solemnly approving a new, rigged terminology . high school Tatum and Connell continue: The American College of Obstetrics and Gynecology (ACOG) published in 1972 its book on terminology Obstetrics and Gynecology. In this text, conception is defined as the implantation of the blastocyst. Conception is therefore not synonymous with fertilisation. Gestation is defined as the state of the woman after conception and up to the completion of gestation. The same question was the subject of a study in September 1985, at a meeting of the International Federation of Gynaecology and Obstetrics (FIGO) in West Berlin. On that occasion, the committee Medical Aspects of Human Reproduction, chaired by M.F. Fathalla, M.D., of Egypt, was commissioned by the FIGO Governing board , in response to a request from the World Health Organisation (WHO), to establish a precise definition of the term gestation. The committee agreed on the following position: Gestation begins with the implantation of the fertilised egg. Following the above definitions of conception and gestation, an abortifacient is that which acts to interrupt gestation, which only occurs after implantation.
As we can see, the father has disappeared from the field of the transmission of human life: he no longer exists as a biological and moral agent in the procreation of a new human being. We see that something fundamental has been left out: the decisive first days of the floating but incredibly active existence of the pre-implanted embryo. But it is still worth following Tatum and Connell to the end of their argument: From a scientific point of view, a recent publication by Segal et al. reports on the sequential serum levels of human chorionic gonadotropin in IUD carriers. They state that 'Our study demonstrates that IUD users do not retain their natural fertility and that IUDs do not exert their anti-reproductive effect as abortifacient agents'.
They do not tell us how this effect is produced. They conclude: If a confirmed pregnancy is detected in an IUD carrier, it must be assumed to represent an isolated case of contraceptive failure.
The case is ready for judgment. The arguments, riddled with claims of principle and skilfully manipulated, allow Tatum and Connell to conclude: Hopefully, these official definitions and the new scientific data will provide a realistic and scientific basis for a clearer understanding of the mechanism of action of IUDs among the public, theologians, politicians and health workers in general.
Nothing is said about what happens to the embryo between fertilisation and nesting, neither about its biological entity nor its ethical status during these important days. The experts, the official authorities have decided to ignore its existence. It is disturbing to see the naïve frankness with which the pre-implantation embryo is reduced to nothing by decree. Official science disregards it, ignores it: it is a non-existent.
But what is equally serious is that the argumentation of Tatum and Connell, which typically represents the position of 'official science', succeeds in placing a single and identical moral label of innocence on anovulatory contraception, interception and early abortion, through a play on words and redefinitions that allows the ontological and moral significance of the pre-implanted embryo to be ignored. This distorting misrepresentation of concepts is the cornerstone of birth control in the future.
With the support of organised science, it has become official doctrine that the crucial biological time between fertilisation and nesting is of no interest to clinical embryology, to the physiology or pharmacology of reproduction, and, not surprisingly, to ethics as well.
To propose and disseminate this doctrine is clearly an unscientific, manipulative attitude, since it is not based on observation of the facts, but on their partial, capricious and voluntarist suppression. By redefining conception and gestation, a window of moral irresponsibility is created: the destruction of the pre-implantation embryo cannot be called abortion, nor can the agents that kill them or make the nesting of the pre-implantation embryo impossible be called abortifacients. But the reality is clear and undeniable: many contraceptive agents act through the destruction of human beings in the days of their floating existence from fertilisation to nesting.
But it has not been necessary to wait for development for contraceptives with abortifacient action to understand the continuum that contraception and abortion form. More than twenty years ago, when abortion laws were taking their first steps in advanced countries, Emily Campbell wrote in the International Inventory of Information on Induced Abortion: Abortion and contraception should be considered conceptually as complementary elements, applied in a total system of birth planning and fertility control. Abortion is often described as the most frequently used mode of birth control and possibly also as the procedure by which the largest issue number of births has been prevented. And it is true: induced abortion has played a more prominent role than contraception in the fertility decline experienced by the developed Western world.
This prophecy will come true if, in September and in Cairo, thesis succeeds in including abortion among the ordinary means of birth control.
Thus, from the beginning, contraception and abortion have been seen as mutually complementary, have progressed towards an ever fuller symbiosis, have been integrated into a unity. The proposal of the work document for the Cairo lecture to give abortion the official status of an ordinary means of contraception is not a newly minted monstrosity: it has long antecedents.
Let us look at a very recent example of how there are no longer conceptual barriers between contraception and abortion. The safe sex campaign has been a tremendous and painful failure, especially among young people. The frivolity with which, at least in my country, the health authorities administered the campaign and the casualness with which it was received by the young people at whom it was aimed were equally chilling. Instead of strengthening the will and moral courage of adolescents and young people, the campaign led to an increase in promiscuity and casual sex. Virtually nowhere was the need for behavioural change made sufficiently clear. The campaign was based on the premise that sexual libertarianism is the ordinary form of human behaviour, and that irresponsible sexual behaviour by young people is inevitable.
But statistics are beginning to show that, despite the efforts of the condom campaign and the activity of contraceptive services, the increase in the incidence of sexually transmitted diseases, including HIV infection, is a tragic reality in the group youth age group. The issue of pregnancies and abortions among 15-19 year olds has also risen shockingly. Following the failure of condoms to reduce the high rate of pregnancy among schoolgirls, health authorities in some US cities have decided to make Norplant available through school-based medical clinics promote . This is a long-acting progestin in capsule form, implanted under the skin, which, by releasing small amounts of the active ingredient, has a contraceptive effect. The contraceptive effect usually lasts for about five years unless the implanted capsules are removed. Norplant interferes with fertility through a number of effects, including blocking implantation of the fertilised egg.
To put it mildly, Norplant is a 'hard' contraceptive, not only because of its long-lasting effect, but also because it includes an antinidant, i.e. abortifacient, component. The fact that the health authorities have resorted to it is, on the one hand, test that the condom campaign has failed. But on the other hand, it clearly indicates that for these authorities, the ethical distinction between methods that prevent fertilisation, such as condoms and other barrier methods, and methods that cause the rejection of the young embryo, is irrelevant internship . It is painful that the conscience of many health authorities has hardened to the point of not distinguishing between one procedure and the other. It is also painful that they consider young people to be refractory to any moral message. They simply offer them, as so often happens in the pragmatic society in which we live, a chemical product as a substitute for virtue, for moral effort.
It is this same pragmatic drive that has presided over the evolution of oral contraception. With the aim of minimising side effects, the mechanism of action of contraceptives has become 'harder' over time. From the initial anovulatories and barrier methods, the focus on internship for the present and research for the future has shifted to antinidatories and early abortifacients. In general, modern oral contraceptives act through multiple mechanisms of action; but none of them is free of an antinidatory effect: quantitatively minor, but ethically significant, in those that combine oestrogens and progestins; very important in others, especially in the case of the 'mini-pill' and long-acting progestins, which exert a predominantly antinidatory action. Pharmacological effectiveness and safety for women have been gained at a high ethical cost.
Nothing reveals the close relationship between contraception and abortion better than the programs of study on the contraceptive and abortifacient potential of the compound RU 486, also called mifepristone.
b. Mifepristone, the molecular bridge between contraception and abortion
It is curious: mifepristone is a pharmacological agent which, depending on how and when it is administered, can act sometimes as a contraceptive, sometimes as an antinidant and sometimes, finally, as an abortifacient. With antiprogestins, and mifepristone in particular, the contraception-abortion continuum is completed at the molecular level.
It is, first and foremost, the most intensively studied abortifacient. When mifepristone is administered alone, it is not very effective, causing abortion in only 64-85 per cent of women with pregnancies of seven weeks or less. Moreover, in 10 to 30 per cent of cases, induced abortion is incomplete and must be terminated by surgical evacuation. But combined with certain prostaglandins, mifepristone is capable of inducing abortion in 92.7 to 99 percent of pregnancies of seven weeks or less. These high fees abortion efficacy rates have been achieved after much research searching for the most effective way to combine mifepristone with prostaglandins. The side effects of treatment are sometimes very severe, and mostly due to the prostaglandin. Proponents of pharmacological abortion are pleased to note that they are gradually gaining ground over their rivals surgical abortion, despite the disadvantages of procedure, because in addition to the side effects, the woman must make at least four visits to the doctor before and after the abortion. According to a published work , 88 per cent of women who had undergone a medical abortion answered in the affirmative when asked whether they would choose this method over surgical abortion if they had to undergo another abortion.
But mifepristone can also be used as a contraceptive. Interestingly, depending on how, how much and when the product is administered, contraceptive patterns can differ markedly from one another.
It can exert an anovulatory effect in several ways. If administered in a single high dose in the late follicular phase, it transiently slows the maturation of the dominant follicle and delays ovulation. The use of low doses (10 to 25 mg) of RU 486 in the late follicular phase, pre-ovulatory days, appears to cause suppression of ovulation. Continuous ingestion for 30 days of 2 mg daily also inhibits ovulation and delays menstruation. If this latter regimen is combined with the periodic addition of a progestin, endometrial secretory transformation is triggered and well-controlled bleeding is achieved, although ovulation is not always blocked.
It is possible to induce an anti-implantation effect. Mifepristone has a stronger effect on the endometrium than on the pituitary gland. The administration of either a single dose of 200 mg at the beginning of the post-ovulatory phase, or 10 mg for 5 to 8 days during the same phase of the cycle, causes endometrial desynchronisation, which often, but not always, makes embryo nidation impossible.
Mifepristone can also be used as an abortifacient contraceptive. It was considered for use as a 'menstrual regulator' or 'single-dose monthly contraceptive (next month's pill)', administered monthly during the late luteal phase, to induce menstruation whether or not pregnancy has occurred. But the results show that this use should be discarded, as it shows a failure rate of around 18 per cent, similar to the failure rate observed when mifepristone is used as an abortifacient in women with pregnancies of less than seven weeks. To act as an effective monthly contraceptive pill, RU 486 would need to be combined with an anti-gonadotropin-releasing hormone or an oral prostaglandin.
It has also been tested as a 'postcoital contraceptive', within 72 hours of intercourse. Here it has shown greater efficacy and better tolerability than the combination of ethinyl estradiol and norgestrel.
Mifepristone has not been result, so far, the ideal contraceptive. I think, however, that data is sufficiently persuasive: mifepristone is a molecular bridge between contraception and abortion.
I turn to the second point:
2. The deliberate confusion of terminology as an instrument of psychological and moral manipulation.
The acceptance of abortion as sociologically and ethically normal in large sections of modern society was made possible in the first place by the wide spread of contraception in that same society. Contraception deeply introduces people to the practical conviction that children can be programmed, that they can in fact be had at issue and at the desired time. Birth control brings with it reproductive freedom: pregnancies, children, are classified as wanted and unwanted. Abortion is progressively establishing itself in society as the final, if not the only, fertility control procedure .
But this acceptance would never have been so rapid and so widespread if it had not involved the manipulation of language. The replacement of the tradition of respect for life - the heritage of many cultures, especially Christianity, and also of the Hippocratic ethics of medicine - by the new utilitarian mentality has been made possible by the obfuscation of minds through the borrowing of words. Besides the sly adulteration of definitions, of which we have just seen a few examples, the creation of padded neologisms, soft in appearance, but with a hard and destructive core, has played a decisive role in the mutation of moral attitudes. Thanks to the new language, new attitudes and behaviours, which had hitherto been regarded as repugnant or immoral, began to take on a semblance of dignity, and ended up being imposed as norms of good civil ethics.
We have just seen how the redefinition of conception and gestation by ACOG and FIGO has been sufficient to displace the pre-implanted embryo into a limbo of penumbra or moral obscurity. But it is worth knowing in some detail the role of the tricky terminology in the social implantation of abortion: its diffusion through advertising technology, the use of persuasive formulas, of syntagms that dignify abortion, of expressions that tarnish those who oppose it.
The perversity of abortion is psychologically camouflaged or nullified when the act of destroying a human life is hidden under new and innocent expressions, which are at the same time scientific, progressive, technical and tolerant, such as 'microaspiration', 'menstrual extraction', 'voluntary termination of pregnancy' or simply 'interruption', 'menstrual regulation', 'menstrual regulation', 'menstrual induction', 'interception', 'monthly pill'. In the artificial world thus created, to speak, in connection with abortion, of killing, murdering, or destroying human beings, is considered uneducated and in bad taste, since this terminology indicates that the values of individual autonomy, the right to choose, the progressive hominisation of the foetus, the rejection of overpopulation, the ecological respect for nature, the social responsibility to contribute to not degrading the surface of the planet have not been grasped.
Pro-abortion activism has ceased to be crude pro-abortion militancy. It has become more sophisticated: today it prefers to talk about defending civil liberties, to propose tolerant pro-choice attitudes, to argue for just feminist demands. Recently, in the United States, some demonstrators shouted and carried signs saying Abortion is beautiful! The slogan did not succeed because, besides being too radical, it resurrected the word abortion. The ideal of pro-abortion activism is to maintain a civilised exterior, and a calm militancy: violence is left to the rescue actions of pro-lifers. Rather than shouting, it is preferable to lull society with promises of ecological well-being and the exercise of individual freedoms. From a dialectical point of view, it is preferable to forget about harsh words, especially since a very scientific and reassuring neologism is available to cover abortifacient contraception and pharmacological abortion. The new word is counter-management.
Emile Etienne Baulieu, the father of the abortion pill, mifepristone, has specifically coined the term counter-management to tactically designate all variants of pharmacologically induced abortion. The new term is first of all required by the convenience of not referring to abortion in the discussion of mifepristone reference letter . Baulieu explained the reason: My purpose is to eliminate the word abortion, because this word is as traumatic as the fact of abortion itself. But the main reason for the neologism is to highlight the fact that the abortion pill is not, by the very fact of being abortifacient, a novelty in the field of birth control. Baulieu states that many methods of fertility control are not contraceptive in the common and accepted sense of the term. This is the case with intrauterine devices, hormonal contraception based on gestagens and postcoital contraception. In fact, post-fertilisation termination, which should be considered abortifacient, is available at agenda. The idea of abortion has a violent and controversial connotation, as if, collectively, consciously or not, we are only concerned with whether or not fertilisation has taken place, and forget about the multitude of stages that must take place for a human being to develop. Considered in its totality and continuity the process of generating life and the natural selection mechanisms that determine its development, to use, when it comes to abortion, terms such as 'murder' or 'killing' only serves to obscure the real terms of a problem that is only about health. For this reason, I have proposed the term 'counter-management', a contraction of 'counter-gestation', to include most methods of fertility control. Hopefully, this new term will help prevent discussion from getting out of hand.
It is clear in Baulieu's words that he intends to amoralise, to place the transmission of human life on an ethically neutral terrain and to reduce it to pure biology. To say counter-management instead of abortion disconnects such an action from any moral implication, from any relationship with God. It is subjected to the mere civil laws that regulate the internship of abortion and to the politics of technical efficiency and demographic control. The lexical change is also meant to imply that the concern for the anthropological and moral significance of fertilisation, just another stage in a biological continuum, is obsessive and unfounded. Once the neologism is introduced, it automatically becomes perverse, or at least obscuring and in bad taste, to use expressions with moral content - murder, killing - when dealing with abortion. The term counter-management is not only atraumatic: it anaesthetises the moral conscience, because it no longer awakens a association of ideas with the process of transmitting life and the role of women in it, but only with the general administration of affairs.
There is also an unexpected effect of the introduction of the term counter-management: the promoters of the new word claim, not so much a kind of patent for its exclusive use, but the right to define the new moral order that counter-management inaugurates. Any objection to the legitimacy of the word and the morality behind it is violently rejected.
A very brief polemic in the pages of JAMA demonstrates this. In a letter to publisher, Godefroid reproached Baulieu for the laughable nature of his ethical assessment of chemical abortion in his Lasker Lecture, pointing out that the tactical change of terminology does not change the moral substance of the actions, and that it is obviously abusive to call fertility control what is, in reality, the eviction of a human being from the womb. Baulieu, displaying in a very typical manner a trait of his character which is to insult and despise those who dissent from his opinions, sophistically reproached Godefroid for having used 'a language designed, thanks to a profoundly unscientific semantic manipulation, to provoke an a priori rejection of the facts and ideas implied in the idea of counter-management'.
We all know how necessary it is in the scientific context to use a precise, unambiguous terminology . The language of science is an instrument of high precision, in which words must designate realities with stark objectivity. The good scientist knows how to draw a clear separation between observed and proven data and imagined hypotheses or plausible but as yet unproven explanations. It is not permissible for the scientist to falsify reality, nor to deny its existence or that of any of its components.
3. The trivialisation of abortion, the final consequence of the contraception-abortion continuum
It is curious to see how contradictorily mifepristone has been received among feminists. Some groups see it as the summum of women's degradation and sexual enslavement. Many others see it as the first real step towards women's sexual liberation.
In fact, the technical mastery of reproduction has already been included in the list of women's rights. And there has been no shortage of politicians and doctors who have rushed to recognise this right, perhaps in search of women's votes or money. In November 1988, Claude Evian, then Minister of Health in the French government, ordered signature Roussel-Uclaf, the laboratory pharmaceutical company that manufactures mifepristone, to resume distribution of the product, which it had suspended a few days earlier in the face of pressure from pro-life groups. The minister justified his order in the interest of public health, and to support women's rights. Almost simultaneously, more than 1000 gynaecologists attending a congress in Rio de Janeiro threatened to boycott medicines marketed by Roussel-Uclaf if she gave in to pro-life demands, as they considered the withdrawal of RU 486 to be 'a blow to women's rights'.
Whether or not it is a woman's right, early and deliberately inadvertent abortion will never be free of psychological and conscientious trauma. The emotional impact of surgical abortion, with its necessary travel to a clinic, anaesthesia and invasive nature, is undoubtedly more intense. But 'home' abortion is not without its stresses and anxieties. Unmedicalised abortion leaves the woman left to herself and in the uncomfortable company of fear, pain and the fear of haemorrhage. The perfect abortion pill favours a woman's privacy and secrecy, but condemns her to loneliness.
But what if a safe and efficient anti-abortifacient pill were to be widely used, dispensed by the pharmacist in his office without the need for a doctor's prescription? Then, it is said, women would become de facto masters of their reproductive capacity. Such a pill, taken monthly as a 'menstrual inducer', would grant her total reproductive autonomy, while at the same time removing the guilt feelings associated with abortion. The woman would no longer have to worry about whether or not she has conceived. It would be enough for her to cleanse her uterus Chemistry at appropriate intervals. It would be the fusion of contraception and abortion in the new notion of counter-management.
The effects that this hypothetical acceptance and generalisation of pharmacological abortion could have from the point of view of medical ethics are incalculable. Some years ago, in 1985, I described the threat of the trivialisation of early pharmacological abortion as follows: The significance of this abortion subject is extremely important: it will establish as a socially accepted fact the notion that the human embryo is a mere waste product. Not only is the embryo reified, stripped of its human value: it is reduced to the negative condition of an excreta. Just as a laxative is able to rid the lazy colon of its faecal contents, the new pill will free the pregnant uterus from the embryo growing in it. Disconnected from the mother by a precise mechanism of molecular competitiveness between anti-hormones and hormones, and catapulted towards the sewer network by the action of specific stimulators of the uterine myocyte, the embryo ends its existence without pain or glory. The transmission of human life, the supreme capacity of man to bring men into being, that participation in the creative power of God, will thus become a function of the same physiological, psychological and moral rank as urination or defecation.