On Their Own Terms

This is how it works: first, one pill in the doctor's office or at the clinic, and, a day or two later, a second set of pills at home. Then the waiting, with a husband or a girlfriend, watching television or reading a book, feeling sad or relieved or numb or frightened. Cramping, bleeding, pain and finally the end of a pregnancy.

This is not a best-case scenario. Best case is that contraception is always successful and pregnancies are always welcome. But that's not always how things turn out. And between the clinic demonstrations, the political discussions and the imprecations from the pulpit, too many American women have come to feel that their pelvis is public property. Slowly, quietly, a new abortion method has become part of the landscape, and it's no accident that those women who have chosen it often cite reclaiming privacy and control as the reason.

RU-486 was originally called the French abortion pill, after the country of its genesis, and many activists spoke of it as the answer to the rancorous, sometimes violent atmosphere that for so long had surrounded legal abortion. Clinics were being assailed by those armed with picket signs and, sometimes, guns; in part because of that, fewer physicians were training to perform surgical abortions. Medication abortions were said to be the answer to both problems.

But after the method was approved by the Food and Drug Administration in 2000, the expected rush to what were called medical rather than surgical abortions didn't happen. "Sometimes we forget that it always takes time for things to change in the medical community," said Vanessa Cullins, the medical director of Planned Parenthood of America. The public interest in RU-486 ebbed—except among pregnant women who didn't want to be pregnant anymore, where it steadily grew.

It's an early method, prescribed only before nine weeks, and consists of two medications, one that blocks the hormones that support pregnancy and another that triggers uterine contractions. And at Planned Parenthood facilities, fully half of those eligible now opt for it. But that's only part of the story. Family-practice doctors, gynecologists and other physicians are beginning to prescribe it to their patients rather than send them elsewhere. "I've treated her for 14 years," one such doctor, who did not want her name used for fear of harassment, said of a woman to whom she'd given the drugs. "Why would I not treat her in this situation when there's a simple way to do it?"

RU-486 flies in the face of anti-abortion orthodoxies, and not simply because some physicians who have never dreamed of performing a surgical abortion have no qualms about making the medication available. It counters the irresponsibility myth, which suggests that women who end pregnancies are thoughtless, feckless, and have not bothered with birth control or matrimony, despite the fact that many women who have abortions are married and were using contraception that failed. RU-486, which now accounts for 14 percent of all abortions nationwide, demands a high degree of responsibility. A woman has to ascertain early that she is pregnant and then take charge of the process herself, choosing to deal at home with the results. With every new political power shift the abortion issue arises again, with talk of a search for common ground and the future of Roe v. Wade. But change in party or philosophy cannot change this undeniable fact: women who do not want to be pregnant will try to end their pregnancies. They will do it because they don't have enough money, or enough support, or they think they are too young or too overwhelmed by circumstance. They always have, and they always will. Rat poison, Lysol, ergot, bleach—oh, the historical list of desperate measures is long. Over the years some have died, leaving motherless children behind.

Even today, there are women using extralegal means because of shame, denial and expense. An ulcer medication called Cytotec, which contains the drug used in the second part of the RU-486 process, has surfaced as the abortifacient of choice among immigrant women, who buy it bootleg at bodegas or get it from friends in Mexico. (You can also buy it online in less time than it takes to order a cardigan from J.Crew, which means that if Roe were to be overturned, the Internet would become the alternative to the back alley.) Doctors say Cytotec alone does not work as safely as the combination of drugs in RU-486 does, and in some cases women have been prosecuted for using it. South Carolina went after a 22-year-old migrant farm worker who said she had taken Cytotec because she had three children and didn't think she could support a fourth. State authorities held her in jail for four months while considering whether to charge her with murder under a statute prohibiting self-induced abortion. Of course, if she'd had another baby and floundered while trying to raise a family on subsistence wages picking vegetables, she might well have been accused of neglect.

I would suggest that you try putting yourself in her situation, but the problem here is with strangers passing judgment on other people's situations in the first place. That's why more and more women are choosing RU-486, because it enables them to take care of their own business in their own homes. No outsiders allowed. If we could travel back in time, before government was invited into the practice of gynecology, we might choose precisely this sort of private ritual. A glass of water, some pills, a decision that may be pragmatic or painful or both but is, above all, personal. Never has the word "choice" been so clear.

© 2009