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"The Moral Property of Women": Bringing Medical Abortion to the United States
SFMMS Advocacy Case Study “THE MORAL PROPERTY OF WOMEN”: BRINGING MEDICAL ABORTION TO THE UNITED STATES
Steve Heilig, MPH
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In late 2021, it was reported that just over half of all abortions in the United States were done via oral medications. Now these pills are a central element in the political battles over abortion. And therein lies a story.
Way back in the late 1980s, scattered reports begin to appear in the European medical literature about an oral medication that could interrupt early pregnancy both safely and effectively. It was called RU-486, for the French pharmacological company Rousell Uclaf. From these earliest papers it seemed clear this couldbeanextremelysignificantdevelopment.Abortionwas of course a highly politicized issue, and for years those opposed to it had found ways to make it hard to obtain safely, and even mounted physical attacks on clinicians – some of whom were murdered – and clinical settings where it was provided. Such a medicationwouldmakeitdifficulttotargetthosewhoprovided or took it. And of course most women, given the choice, would prefer a medication option to a surgical one, even if that surgical procedure was the most common one in the nation.
At UCSF campus newspaper, I began to cover this developing medication,publishingsomeofthefirststoriesonitinthe country. The Europeans were far ahead of us and soon RU-486 had garnered enough evaluation to be approved in nations such as France and England. At the San Francisco Medical Society we already had a good track record of bringing new policy positions to the California and American Medical Associations, so I drafted a policy resolution stating that American women
– Isaac Sasson, MD, PhD,
reproductive endocrinology/ infertility specialist, American Society for Reproductive Medicine, New York Times
and physicians should have access to this medication already approved overseas. Our physician delegation adopted it and it was only a little surprising that so did the CMA and AMA – the latter garnering some national media stories. I also published a survey of California OB-GYNs indicating that many would prescribe the medications if allowed. We also drew up a research protocoltoconfirmwhatwasalreadyknownaboutthepillsin France,ascientificallybutnotmedically-indicatedeffort,for RU486 had already been called “the moral property of women” by the French minister of health. At the same time, a small group of physicians and other health advocates began to meet at the SFMS headquarters, seekingtofindawaytospeedapprovalofthisbreakthrough medication in our politicized nation. Working with a veteran New York abortion rights advocate, Lawrence Lader, we hatchedaratheraudaciousplan:Wewouldfindapregnant womanwhowishedtouseRU-486,flyhertoEuropetopick upthepills,flyherback,andintentionallyhaveher“busted” for smuggling an unapproved drug into the United States, with major media there to cover it. It was also the time of a heated Presidential election between Bill Clinton and incumbent George H.W. Bush, and we wanted to insert this issue into the campaign debates if possible too.
In short, this “stunt” worked just as planned. The patient was detained, her medications impounded, and the story hit the front pages and television news nationwide, vastly expanding awareness of this medical option and the politics surrounding it.Courtbattlesensued,expeditedduetothepatient’scondition. We prevailed. Clinton vowed to bring RU486 to American women,andotherleadingfiguresweighedininagreement.Back home, we had to hide the patient from massive media interest –we’dtriedtoprotecthername,butonetheorywasthatan enterprising reporter bribed the airplane seating chart out of an airline employee - but she got the care she needed. TIME magazine then called RU486 “The Pill That Changes Everything.”
However, due more to political than medical factors, it still took eight years, until 2000, for the FDA to approve mifepristone/ misoprostol in this country. That was better than delaying forever, as many feared would occur, but even when approved there were restrictions attached many experts felt unwarranted by evidence, and still do, for now vast clinical experience has shownsuchregulatorybarriersaren’tneeded.Primarycare providers can safely use them with patients, and many now even believe they should be available over-the-counter. Thus there is concerted research into how these medications can be used safely and effectively without such restrictions, and new advocacy for increased availability, especially in light of the likelihood of Roe v. Wade being overturned and very many patients in need in areas where abortion becomes unavailable. The SFMMS has already proposed policies to CMA and AMA on these fronts.
Three decades on, it is ironic, frustrating, and sad that this isallnecessaryatthislatedate.Butwewon’tabandonwhatis right for those in need.
Steve Heilig, MPH is the Director of Public Health and Education for the SFMMS.
References
Heilig, S. New French Abortion Pill Stirs Hopes, Fears, Debate UCSF
Synapse (31):15:January 29 1987 Heilig S. RU-486: The Pill that Could End the Abortion Wars and
WhyAmericanWomenDon’tHaveIt JAMA.1991;266(8):1141. Heilig S: RU-486: What Physicians Know, Think, and (Might) Do – a
Survey of California Obstetrician/Gynecologists Law, Medicine and Health Care 1992; Fall 20(3):184-187 Heilig S, Wilson T: The Need for More Physicians Trained in
Abortion: Raising Future Physicians' Awareness Cambridge
Quarterly of Healthcare Ethics , Volume 8 , Issue 4 , October 1999 , pp. 485 – 488 HiltsP:AbortionPillsareConfiscatedbyUSAgents NewYork
Times, July 2, 1992 Bellack P, Stolberg SG: Abortion Pills Stand to Become the Next
Battleground in a Post-Roe America New York Times, May 5, 2022 Medical Abortion: UCSF Medical Abortion | Conditions &
Treatments|UCSFHealth https://www.ucsfhealth.org/ treatments/medical-abortion