In case of emergency

The difference between RU-486 and the morning-after pill.

The “morning-after” pill—commonly sold under the brand name Plan B in Canada—is a form of emergency contraception. It’s used after unprotected sex or birth control failure, and works up to 72 hours after the incident (not just the morning after). Plan B is available over the counter by asking a pharmacist—no prescription needed. Just like NicoDerm patches and Sudafed.

But Plan B won’t work if the pill-taker’s pregnancy is established; that is, if the fertilized egg has implanted into the uterine wall.

Although Canadians for Choice’s Norman Barwin says there has been research looking at RU-486 as “a post-unprotected intercourse method of contraception,” he doubts that’s where the confusion lies between the abortion pill and emergency contraception.

Maybe it’s the recent media coverage of Plan B, which was only approved as an over-the-counter drug in Canada in April 2005. Maybe it’s that one thing the two drugs have in common is that both are bees in the corset of the pro-life movement.

Consider: Even though it is an oral contraceptive similar to other forms of birth control, Wal-Mart pharmacies in the US, by policy, do not carry Plan B. (That’s not true in Canada. Pharmacies at Bayers Lake and the Downsview Plaza in Lower Sackville do carry it. The Wal-Mart pharmacist at Bayers Lake says, “We always make sure to keep it in stock.”)

Wal-Mart US says its decision not to stock the drug is based on consumer demand. But in 2005, the US National Abortion Rights Action League and Planned Parenthood Federation of America both launched on-going campaigns to pressure the corporate giant to fill prescriptions.

The US pro-life Pharmacists for Life advocacy group recommends its members refuse to fill Plan B prescriptions because it destroys a fertilized egg by preventing implantation. That is, it ends life. Like RU-486.

Herman Wills of Campaign Life Coalition is of the same mind. “Emergency contraception sounds good,” he says, “but again, is it contraception? The egg has already been fertilized

The American experienceBill Clinton and the drug formerly known as RU-486.

American women have had access to RU-486 since September 2000.

Actually, no. They haven’t.

They’ve had access to the drug under another trade name, Mifeprex. You’d think the brand name wouldn’t make a difference. RU-486. Mifeprex. Who cares? After all, it’s exactly the same chemical compound—mifepristone—that was first developed in France in the 1980s. It’s just a different logo. But oh, what a difference.

RU-486 came to the attention of American doctors and reproductive freedom advocates around the same time it was first developed in France. In the decade that followed, it endured much the same corporate and political stagnation it suffers now in Canada. Despite the support of national medical and feminist organizations, Roussel-Uclaf’s parent company, Hoechst AG, refused to bring RU-486 to the US Food and Drug Administration for full approval due to the threat of economic repercussions against its other products.

In 1997, Hoechst AG spokesperson Catherine Euvrard told reporters in Paris that “Roussel-Uclaf no longer has the means to be able to withstand the boycott threats.”

That announcement came one week after the National Right to Life Committee and its pro-life allies had announced a boycott of a popular Hoechst AG-produced allergy medication called Allegra.

Euvrard told reporters it simply was not worth risking Hoechst AG’s $1.63 billion in US sales over a single controversial medicine. “This product,” she said, “can no longer be part of the strategy of an international company.”

None of this boycott stuff was supposed to happen. Or, at least, President Bill Clinton did his best to diffuse the boycott bomb when he became a political champion for RU-486 and acted on behalf of the drug as one of his first responsibilities in the Oval Office.

On January 22, 1993—he was only sworn into office on January 20—Clinton launched an executive order charging the Secretary of Health and Human Services with the task of promoting the “testing, licensing, and manufacturing of RU-486 or other antiprogestins.” In a nutshell, Clinton asked Roussel-Uclaf to bring the drug to America and offered to take the heat for inviting it in.

Roussel-Uclaf wouldn’t take the bait. In February 1993, the FDA announced by way of a press release that Roussel-Uclaf believed “RU-486 should be made available in the United States,” but…big but…“the firm emphasized the importance of finding a way to achieve that goal without the involvement of Roussel-Uclaf.”

After a year-long back-and-forth between Roussel-Uclaf and the FDA, the company signed over RU-486’s patent rights to a US-based non-governmental organization promoting global reproductive health, Population Council. Roussel-Uclaf gave away the rights for free. One condition? The company insisted the name RU-486 never be used in the US.

Population Council held clinical trials, found a manufacturer on US soil and came up with a new brand name. RU-486, reborn as Mifeprex, was approved for sale in the US in September 2000. Clinton’s political will bore fruit almost eight years after the fact. Good thing it was on top of the to-do list.

Safety and numbersHow dangerous is RU-486?

The American College of Obstetricians and Gynecologists pegs the fatality rate of RU-486 at less than one death per 100,000 procedures.

“For perspective:” wrote Vivian M. Dickerson, president of the ACOG in a November 2004 letter to the New York Times, “it’s less than the fatality rate from a shot of penicillin (2 deaths per 100,000 cases) and nearly identical to women’s low death rate from common miscarriage. It’s far less than the fatality rate for childbirth (about 12 maternal deaths per 100,000 births), and its risks are lower than those for dental procedures and hernia operations.”

Though pro-life groups don’t dispute the overall numbers, Campaign Life Coalition’s Herman Wills says it “doesn’t really matter. One death is one too many. Forget about the pro-choice thing; that’s just getting into semantics and politics. You have to think about the health of women.”

Wills also cites the fact that at least six North American women have died after taking RU-486—five Americans and one Canadian involved in a Vancouver clinical trial in 2001.

“That was caused by septic shock, a rare infection,” says Health Canada’s Jirina Vlk.

Margo Burke, the president of Nova Scotians United for Life, notes the medical concerns, but worries more about the toll abortion, in pill or surgical form—”the end result is the same”—takes on women.

“We don’t like to see women taking drugs that maybe aren’t necessary and maybe aren’t as helpful in the long run,” she says. “We understand that there are certain circumstances that a woman is going to find herself in, that she’s going to find herself under pressure to make this choice and we want to say: Can we help you otherwise? Can we give you a better, healthier life choice? And that goes for RU-486.”

One of Burke’s organization’s main focuses is Project Rachel, an international post-abortion emotional and spiritual healing program of the Catholic Church.

“I know that when we address women who have had abortions,” she says, “they know how critical it has been for them and they have gone through horrific stuff. It damages people’s lives.”

Norman Barwin of Canadians for Choice says RU-486 has risks. But so do other drugs.

The key, Barwin says, is to “follow the rules of the road.” He means taking it early in pregnancy, receiving counselling and following up with an ultrasound and pregnancy test.

“You can’t drive a car without a risk of accident. You wear your safety belt to reduce the risk; the same thing happens with RU-486,” he says. “That’s why I believe it’s so important that we have good access to abortion services. So patients can get good medical care and they can get access to that care.”

But not all Canadian women who manage to access RU-486—or, back to that crucial name issue, Mifeprex in the US—are necessarily following the “rules of the road.”

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