It caused a bit of a stir in 1991 when three “pro-choice” feminists came out with a book warning of the dangers of the chemical abortifacient RU-486. “RU486: Misconception, Myths and Morals,” written by Renate Klein, a biologist and social scientist from Deakin University in Melbourne, Australia, Janice Raymond, a professor of women’s studies from the University of Amherst (Massachusetts), and Lynette Dumble, a member of the University of Melbourne’s Department of Surgery, won awards and received some momentary coverage in the press. But ultimately, the pro-abortion establishment pushed back and plowed ahead, ignoring the warnings.
Approved in the U.S., the chemical abortion method is now legally on the market in at least 50 countries. The U.S. Food and Drug Administration (FDA), which approved RU-486 in September of 2000, says that 1.5 million women had used the drug as of April 2011. In Europe, one international group promoting chemical abortifacients says that as of 2009, RU486 had already been used by two million (womenonweb.org, accessed 11/19/13, at www.womenonweb.org/en/page/561/is-a-medical-abortion-dangerous).
The notorious chemical abortion method is, of course, actually a two-drug combination. RU-486 (known as mifepristone) blocks the hormone that creates and sustains the safe, nurturing environment in the womb where the young baby grows. Misoprostol, the prostaglandin given a day or so later, initiates powerful uterine contractions to dislodge the now starved child.
Over the past several years, there have been modifications of dosages, the addition of antibiotics to some regimens, new warnings have been added to the label.
Does any of this satisfy Renate Klein, one of the original feminist critics?
Writing in a ninety-page preface to a new edition of RU486: Misconceptions, Myths and Morals published earlier this year, far from taking anything back, after seeing twenty plus years of RU-486 on the market, Klein is as convinced as ever that “a down-to-earth rational best practice approach that truly respects women’s health and well being could not, in good faith, endorse this fraught abortion method.”
Klein repeats here what she has published elsewhere–that she sees a ”RU 486/PG abortion as an unsafe, second-rate abortion method with significant problems”
Unapologetically “pro-choice,” Klein explicitly favors surgical abortion as a safer, easier option. But her honest, clear eyed appraisal of chemical methods and the significant risks they pose for women is rare among those who champion abortion as essential to women’s rights.
Ignoring their own evidence
In the new preface, Klein notes a troubling tendency among researchers to catalogue a long list of serious “adverse reactions” (or complications) and then to go on to declare the two-drug combination “safe and effective,” against their own evidence.
One researcher Klein cites is Régine Sitruk-Ware. In a 2006 review of large postmarketing studies in the U.S. and France, Sitruk-Ware found 10% of women suffering from excessive bleeding, 1.4% requiring curettage to control bleeding, and 0.25% requiring blood transfusions.
Though Klein says these sound like low percentages and cites another study that makes these look like underestimates, she points out that for the 1.5 million said to have undergone such abortions in the U.S., this would mean 150,000 women experiencing excessive bleeding, 21,000 requiring curettage, and 3,750 needing transfusions. These are hardly inconsequential numbers.
Sitruk-Ware said, according to Klein, that “Women living in areas where no medical facilities are available should not be included in the medical [chemical] protocol of TOP [termination of pregnancy] unless referrals, and possible transportation are available for emergencies.” Obviously, this is not a statement you heard quoted a lot by the pro-abortionists or their allies in the media during discussions over the Texas law that requires abortionists to have admitting privileges to a hospital within 30 miles of the abortion clinic.
Sitruk-Ware also notes the higher risk of infection, potentially serious drug interaction issues, special risks for asthma sufferers, and risk of “malformations” to the “fetus” should the pregnancy continue. Yet then, Klein notes, Sitruk-Ware, like so many chemical abortion researchers before and after her, goes on to declare that the safety and the efficacy of the method has been confirmed.
While Sitruk-Ware does issue some cautions, Klein says her warnings never show up in the mainstream promotional literature for the drugs.
While “study after study” shows a high rate of adverse effects, Klein says that these are ignored or downplayed in most popular discussions of the drug.
Recounting information that may be familiar to regular readers of National Right to Life News Today, Klein shares data from the April 30, 2011, “Postmarketing Events Summary” put out by the U.S. Food and Drug Administration (FDA). That summary reported 2,207 adverse events, 14 U.S. deaths, 58 ectopic pregnancies, 256 infections, and 339 women requiring transfusions. Klein notes that only 1% to 10% of complications are typically reported to the FDA, meaning the numbers could be 10 or even 100 times higher.” And remember that this was as only of early 2011.
Klein notes that several of these deaths involved the rare bacteria Clostridium sordellii, which prompted a joint investigation by the FDA and Centers for Disease Control in May of 2006. Experts presented evidence that RU 486 might suppress immunity , but the conference ultimately came to no official conclusion on the reason behind the sudden rash of incidents specifically among the population of chemically aborting women and RU-486 remained on the market.
The FDA made it sound as if pregnancy itself [!] was the culprit and simply let stand special warnings added to the label in November of 2004.
Klein says that because RU-486 increases women’s susceptibility to infection, “this means that RU-486 is a drug unsuited for abortion purposes.”
A drug safety information update issued by the FDA in July of 2011 tells patients to contact a health practitioner right away if they “develop stomach pain or discomfort, or have weakness, nausea, vomiting or diarrhea with or without fever, more than 24 hours after taking misoprostol” (the second drug in the process) as it could be an indicator of infection.
Klein says “this advice comes close to being nonsensical,” given the pain, diarrhea, vomiting and cramping that normally accompany these abortions, along with the heavy bleeding. If patients took that advice, Klein guesses that “close to 100%” would be contacting the abortionist, who she expects would simply give the woman reassurance.
Accounts of two deaths contradict industry spin
Renate Klein recounts the cases of two women who died after taking RU-486, Holly Patterson, the beautiful young teenager from the San Francisco area who died of an infection in 2003, and Manon Jones, an 18-year-old who bled to death in Britain in 2005. We will not go through all the details of these cases here, as we have reported on them previously. But these two tragedies serve to illustrate certain important points for Klein.
To Klein, the idea that a woman could simply take powerful medications, go home, and call the doctor if she started having problems was not just “nonsensical,” but dangerous. Klein notes an important difference between chemical and surgical methods.
If something goes wrong during the surgical abortion and a woman begins to hemorrhage, she is already there at the clinic and can immediately receive medical treatment. If she begins to hemorrhage at home, even if she recognizes it as such, she may be miles from any care [and maybe hundreds of miles if she gets her abortion pills via webcam].
Even if she does go to an emergency room, because the symptoms of an afebrile infection (one occurring without the usual fever) or a ruptured ectopic pregnancy are quite similar to the ordinary pain, cramping, and bleeding of a chemical abortion, even a doctor could miss them. Given that similarity, the doctor could examine her, prescribe some additional pain pills, and send her home, just like he did Holly Patterson, failing to treat her infection until it was too late.
A phone call to a hotline is not enough, and even a return visit may be insufficient in these cases. Holly Patterson went to the ER, but only got more pain meds. By the time she returned again to the hospital, it was too late. The outcome was tragic in Holly Patterson’s case, as these infections can be particularly fast growing and virulent.
And exactly how will the patient, or even the doctor, be able to distinguish a genuine hemorrhagic emergency from the gushing blood that accompanies many of your ordinary chemical abortions?
This was hardly a theoretical question when Manon Jones, a British teen, bled to death in 2005. Klein is aghast that medical authorities implied that it was Manon’s fault because she had not returned to the hospital soon enough. To the contrary, Klein points out that Jones returned the hospital twice, even being told on her second visit that the bleeding was normal.
“This example,” says Klein, “is a clear case as to why an RU 486/PG abortion can never be safe because no one knows how these two potent chemicals might react in particular women’s bodies.”
The tendency, intended or not, to downplay or minimize the risks is not just an affront to women’s dignity but a serious threat to their health. Klein notes a pattern here, that “symptoms of RU 486/PG abortion are talked down by abortion providers – ‘just a heavy period with a bit of pain.’”
Klein says the first-hand accounts of those women who have suffered serious complications show a disturbing pattern. The women say that they weren’t told the process could be incredibly painful, could last for hours, could involve vomiting and violent diarrhea, and that they could lose a lot of blood and bleed for weeks.
Klein shares another chemical abortion side effect that has not received a lot of attention in the popular press – debilitating fatigue and depression. Quoting from Norine Dworkin-McDaniel’s article “I was betrayed by a pill,” from the June 27, 2007 issue of Marie Claire, Klein lifts the section where Dworkin-McDaniel says “My body was in hormonal chaos – pregnancy hormones clashing with antipregnancy hormones clashing with stress hormones.”
CLICK LIKE IF YOU’RE PRO-LIFE!
Dworkin-McDaniel talked of “an utter lack of ability to do anything more strenuous that sleep or lie on the couch.” She added that “My brain felt so fuzzy English seemed like a second language, and I couldn’t work.”
Fatigue was followed by depression. “I sobbed constantly. I wouldn’t leave the house. I stopped showering.”
Dworkin-MCDaniel’s doctor prescribed anti-depressants. She didn’t feel like her “old self” for nine months.
Dworkin-McDaniel says that after she reported this to her gynecologist, he informed her that her experience was not uncommon. According to Dworkin-McDaniel, he told her that “I think it’s underreported, but probably one in three have dramatic side effects.”
Why aren’t women being told what a taxing ordeal these abortions could be for many of them? Klein reports one Planned Parenthood clinic saying, “Well, we don’t want to scare them.”
For all their talk about respecting the intelligence and autonomy of women, this is paternalism at its worst.
Concerns about Australia and the rest of the world
One reason Klein was prompted to come forward with an update was that in February of 2006, her own country, Australia, joined the ranks of nations approving RU-486, employing many of the same old kinds of arguments and the sort of flawed research that Klein originally found so problematic in 1991.
When it came to the roll out of chemical abortion, as people found elsewhere, promises did not line up with practice. A 2011 study comparing surgical and chemical abortions in Australia (2009-2010) found complication and failure rates were higher than expected for the chemical methods–1 in 200 hemorrhaging, about 1 in 20 being hospitalized, requiring a “second procedure” to complete the abortion, and a three times higher rate of sepsis than found in surgical.
An early proponent of chemical abortion in Australia, Caroline de Costa, who had originally cautioned that women undergoing these procedures needed to be close to a facility offering emergency care, began promoting use of the drug for women in rural areas, which might be 10-12 hours away in some areas of the outback.
As was the case in America, the Australian story also has a rather sketchy delivery and distribution history. A specially created nonprofit pharmaceutical company (MS Health) of worldwide abortion giant Marie Stopes International (MSI) received license to sell the pills. Like the American producer, Danco, the only products are abortion pills (though MS Health sells both mifepristone and misoprostol).
As Klein was writing the preface this past summer, she expressed concern about a move among some Australian politicians supporting abortion to have the government subsidize the cost of the drugs, thereby creating a financial incentive for women to choose the chemical method.
Klein’s concerns were not limited to Australia, however. From early on, Klein and her co-authors understood that those developing the chemical abortion methods had set their sights on populations in the developing world. And now, she notes with alarm, her fears being borne out.
Not only is the RU-486/PG combination being pushed in the West, but prostaglandins like misoprostol are also being promoted worldwide as cheap, stand alone abortifacients (see our own article, covering much of the same material).
It is especially troubling to Klein that these are being pushed and promoted in poor countries where women, already suffering from ill health, have little access to emergency facilities.
What must be frustrating for Klein is that so many of these problems are ones that she, Raymond, and Dumble warned about in the first edition of their book in 1991. Incredible pain, terrible side effects, heightened risks, the trauma involved in aborting and seeing one’s own child, the effects of the drugs on a woman’s other systems, deaths, efforts to expand dangerous chemical methods to the developing world —all have become a proven reality in the lives of far too many women.
Klein, of course, simply wants these chemical abortions replaced by surgical ones, which she considers safer, quicker, and less traumatic. But she does not think being a feminist and “pro-choice” requires that a woman endorse, promote, or endure a method that is, in her words, “unpredictable, unsafe, and often cruel.”
Obviously, those of us in the pro-life movement can’t help but recognize that for the unborn baby, any method of abortion is cruel and “unsafe.” But Klein shows us here how just how far the abortion establishment is willing to go in putting the lives and health of women at risk to promote their agenda.
 In the 1991 edition of their book, Klein and her co-authors had warned about similar issues with the accompanying prostaglandin.