Catholic Communications, Sydney Archdiocese,
7 May 2013
The Federal Government's decision to consider subsidising RU 486 (mifepristone) or the Abortion Pill as it is popularly-known by placing it on the Pharmaceutical Benefits Scheme is a return to the dangerous days of illegal back street abortions in the 1950s and early 60s.
"RU 486 is unpredictable, high risk and can cause immense pain and nausea, weeks of severe bleeding, rare infections which are often not diagnosed until it is too late, and in some instances may even cause death," warns Dr Renate Klein, biologist, social scientist, women's health researcher and former Associate Professor in Women's Studies at Deakin University, Melbourne.
Being able to terminate a pregnancy in the "privacy of a woman's own home," as is touted by pro-choice advocates by taking two lots of pills - mifepristone first and 24 to 36 hours later, four pills of prostaglandins - is not a win for women, she insists. Instead it is a high risk option with an average failure rate of between 5% and 7%, with a 10% failure not uncommon.
Dr Klein is concerned about the lack of time given to canvass the range of scientific, social, ethical and medical issues emanating from the complexity of RU486/PD abortions before approval for the drugs' use was granted in Australia in August last year. She is equally concerned that despite this, negotiations about price between Health Minister Tanya Plibersek and MS Health, a subsidiary of multi-national Maria Stopes International Australia (MSIA) which holds the rights to distribute a form of RU 486 manufactured in France are now underway.
Although worldwide there are cheaper generic forms of Mifepristone available, in discussing and negotiating taxpayer subsidies for RU486, the Government is dealing only with MSIA's Mifepristone Linepharma which costs around $300 for one pill.
"This is five times higher than the $60 charged by pharmaceutical company Exelgyn for the same 200 mg of mifepristone," Dr Klein says and notes that Exelgyn's Mifepristone Mifeprex has been available to the 187 medical practitioners across Australia registered as "authorised prescribers" by the Therapeutic and Goods Administration (TGA) from 2006.
For six years only registered prescribers could provide RU486 to women but this changed in August last year when the TGA approved RU486 and its companion drug, prostaglandin (PG) for use by Australian women as a "relatively safe and effective way" to terminate unwanted pregnancies. The TGA also granted MS Health, the subsidiary of MSIA to control the importation of both mifepristone and its companion drug, the prostaglandin Gy Miso.
"MSIA is not a pharmaceutical company but is a reproductive health services and abortion provider and imports the drugs from the French manufacturer, Linepharmaa. But its subsidiary, MS Health was also granted the right - indeed the mandate - to deliver an online course for every clinic or GP who wants to become an abortion pill provider," she says.
Dr Klein has equal concerns about the fact that those who undergo the online course not only receive a certificate but have their names placed on a provider registry giving Marie Stopes and MS Health a large amount of control over abortion services in Australia.
By listing both the abortion drugs imported by MS Health on to the PBS, Australian taxpayers will be subsidising a form of RU486 and its companion prostaglandin drug at a far higher rate than is necessary, she says.
"We need to know just how much the tax payer will be contributing to the coffers of MS Health," she argues and is increasingly troubled by the dominance of the multi-national company and its local subsidiaries not only in its control of the distribution of RU486 and its companion drug, Gy-Miso but at the rapid expansion of Marie Stopes' abortion clinics across Australia.
The company operates 15 clinics that provide suction and pill abortions to women in Australia with this number continuing to grow.
While Dr Klein does not describe herself a "pro-choice" advocate for abortion, she does believe there are occasions when there is an overwhelming medical, psychological or other need among women where a pregnancy must be terminated. In these instances suction abortion in a clinic and under the supervision of a doctor and trained medical staff is the far safer and much preferred option, she says.
"One of the main problems of putting Mifepristone and GyMiso on the PBS is that the cost will be reduced to just $36.10 and even less in some special instances. The effect of this is likely to push many more women into using drugs instead of seeking the much safer alternative of a suction abortion, preferably carried out with local anaesthetic," she says.
Co-author with Janice Raymond and Lynette Dumble of "RU486: Misconceptions Myths and Morals" which she is currently updating with a detailed preface of events and clinical research studies since the book with its warnings about the dangers of abortion pills was published more than 20 years ago, Dr Klein says health Minister Plibersek and her advisors have got it wrong. Far from giving women access to a safe service, she says the Government is giving women "easy and inexpensive access to a second rate, unpredictable and dangerous drug cocktail."
Contrary to the 'safe, effective and more natural' mantra put forward by abortion pill advocates, RU486 and the four prostaglandin pills proscribed for chemical abortions forces women to endure days, weeks or even longer of severe pain, bleeding and risk of infection when in some cases only part of the embryo is expelled.
"Each individual woman reacts differently and every case is unpredictable," she says and disputes the popularly quoted idea that the abortion pill is no different from a miscarriage.
"This is not so. It is far more dangerous, can trigger fever, cause vomiting and great pain and can also lead to infection and in some instances life-threatening blood loss."
What is not understood and continues to be overlooked by most women, she says, is that a chemical abortion is not a morning after pill and a simple matter of swallowing a drug and getting on with life.
To undergo a chemical abortion, a woman first takes mifepristone, or RU486, which cuts off nutrients to the child she is carrying in the early stages of pregnancy. "This is a cruel process and weakens the embryo which begins to detach from the uterus," she explains. The second pill containing the synthetic biochemical molecule, prostaglandin is then taken 24 to 36 hours later which triggers contractions to promote the embryo's expulsion from the womb along with rich uterine lining that has held and fed the embryo since conception.
"It is a myth to say pill abortions are not invasive. Blood loss can be excessive and can last as long as six weeks," she says and cites a recent case of a young woman in Bristol, England who died from severe blood loss after an RU486 and prostaglandin abortion.
"This woman lived in a major city near hospitals with facilities for transfusions. Imagine how much more dangerous to prescribe these pills to women living in rural areas, hours away from a hospital or any facility that can perform a transfusion or step in to counter an emergency. It is totally irresponsible and dangerous to think that chemical terminations are safe for women in remote and regional areas."
Chemical abortions also put a woman at risk of developing an infection such as Clostridium, a rare form of bacteria associated with childbirth and more recently - and worryingly - with RU486/Prostaglandin abortions in the UK, Sweden and the USA. As the infection is not accompanied by fever, it is difficult to diagnose and frequently not picked up until it is too late.
Dr Klein is impatient with claims by advocates who back their claims of the safety and "ease" of chemical abortions citing the fact RU486 is recommended by the World Health Organisation and used by millions of women in undeveloped and third world countries.
"Advocates argue that a pill is preferable to desperate women using a stick inserted into the womb or a caustic substance to end an unwanted and unaffordable pregnancy. This is not the right argument. All such methods are wrong and it is to the eternal shame of society at large that we still have millions of women dying each year from unsafe abortions. We also have no way of knowing in Bangladesh or other third world countries if the women who die after an abortion used the abortion pill, caustic solution or some other method. There are no statistics and those the woman turns to are interested in trying to save her life and staunch the bleeding, not in determining the method responsible, especially in countries where abortion is illegal."
For Dr Klein it is time Australians ceased the ongoing and increasing cacophony between pro-choice and pro-life groups. "It is time we had a proper conversation about this issue and understood that an abortion is something the majority of women seek only as a last resort, often in the belief they have nowhere to turn in order to keep the pregnancy. The decision frequently triggers intense dilemmas, emotional turmoil and great sadness."
While strongly believing that in certain cases an abortion may absolutely be needed, Dr Klein is anxious to dispel the myth frequently preached by pro choice lobby groups that access to chemical abortion is about freedom of choice and that terminating a pregnancy is no different from having a tooth out or wart removed, after which life resumes as normal.
"Nothing is that black and white. The issue is complex and we should realise we are all pro life, pro the life of a woman and pro the life of a baby. Instead of polarising the population, it is important we talk about this and have the conversation," she says and argues that releasing a cheap and substandard drug cocktail onto the market to put women even further at risk and in danger is not the answer.
"With RU486, Australia is going back to the future and returning to the grim and dangerous days of backstreet abortions," she says.