What is the abortion pill?

In short

The abortion pill technically called the RU 486 is used for what is called "medical termination of pregnancy". It can terminate unwanted pregnancy up to 63 days (nine weeks). After due consultation and counseling and consent by your gynecologists the pill is taken in his presence and 48 hours later prostaglandin (Misoprostol) pessaries are used. This method is successful in around 95% to 98% of cases and has in effect revolutionized early pregnancy abortions over the world. As it avoids surgery and anesthesia it is much cheaper and relatively much safer than surgical abortions.

The long version

RU486 was invented in France in the late eighties and I was involved in its first clinical trails in the UK in early nineties. The RU 486 molecule is similar to the pregnancy supporting hormone progesterone and its anti progesterone action means the young pregnancy can not survive once you take the pill. Since the level of progesterone by ninth week is low enough such that it could be effectively countered by a single dose of RU486, it is more effective only up to that stage of pregnancy.

Whilst the RU486 will effectively terminate the pregnancy, the process of expelling the pregnancy needs an additional chemical - prostaglandin and that is the vaginal pessary used 48 hours later. Typically the process of expulsion of the pregnancy is completed within a week or two weeks and most often the process happens entirely unknown to the woman. The amount of pregnancy material up to nine weeks is so less that the contents are typically flushed when using the toilet. The general bleeding caused will last a few days like a heavy periods and should cause no more discomfort.

We do not recommend performing ultrasound scan to confirm that the uterus is empty and that is because the blood clots inside can create a false impression that the uterus still has some "products of pregnancy" and thus a "D and C" may be done needlessly.

Risks

1. Betwen 2% and 5% of times the process is incomplete requiring surgical evacuation of the uterus.

2. Misoprostol is a chemical called prostaglandin which can bring on an attack of asthma if you are prone to that condition.

3. There is no concern about future fertility after using RU486.

The ethical issues

It’s been 25 years since its introduction to the market and probably the ethical storms are settled however still remember, the method was criticized as “do it yourself” abortion pack. The feminists called empowering women even further and the gynecologists were concerned that it could reduce their lucrative business of doing abortions. However we have to remember that the introduction of the oral contraceptive pill in the sixties created a storm suggesting that it would make woman more promiscuous. I don't see the RU486 as any different in terms of promoting irresponsible sex. The sexual behaviour of the population has a few other more important influencing factors than the availability of RU486.

I have seen in Mumbai as well as in London, women having repeated abortions because somehow they use it as a method of contraception. That was even before the RU486 was invented. This is obviously unusual but still happens. Couples (especially women), married or unmarried, should realize that the best way is to avoid a pregnancy using good contraception.