RU486 divides Australia like no other pill since The Pill

No pill has divided Australia like RU486 since the oral contraceptive pill was introduced in the 1960s.

The difference is, debate over the contraceptive pill was one which raged worldwide.

Australia appears largely alone in the developed world with its wrangling over whether women should have access to RU486, a synthetic steroid also known as mifepristone, which allows them to abort at home.

Obstetrician Caroline de Costa, the woman who triggered the latest RU486 controversy in an article in the Medical Journal of Australia (MJA) last October, said the drug had been used in about two million abortions worldwide.

"In European countries where mifepristone has been available for some time, there has been no increase in the number or rate of abortions overall, but the proportion of abortions performed at earlier gestations has risen," Prof de Costa wrote at the time.

The World Health Organisation has also added RU486 to its list of essential medicines for developing countries.

RU486 was specifically prohibited in Australia under a 1996 act of federal parliament, yet it has been licensed for use in France since 1988, in the United Kingdom since 1991 and in the United States since 2000.

When used in combination with another drug, such as misoprostol, RU486 results in complete abortion in between 93 and 98 per cent of cases.
In the remainder, the abortion needs to be completed by an appropriate qualified doctor.

"In a very small number of women, heavy vaginal bleeding necessitates hospital admission and sometimes transfusion," Prof de Costa said.
"Infection of retained products of conception is a possibility and antibiotics may be needed."

Australian women already have access to surgical abortion with an estimated 85,000 performed annually.

Prof de Costa believes making medical termination available through RU486 would largely overcome the inequities facing rural women wanting to abort.

Such women often have to travel hundreds of kilometres at their own expense to a private clinic in the nearest large town, a cost she says is sometimes beyond their resources.

"There does seem to be some women who don't have geographic or financial access to what is legal abortion," Prof de Costa, of James Cook University in Cairns, wrote in the MJA.

"Medical abortion should be an option for all Australian women.
"For rural women and for women of some ethnic groups for whom privacy is a particular issue, the option of medical abortion is critical if they are to be treated equally with other Australian women."

Whatever a person's opinion about the rights and wrongs of abortion, the fact remains that surgical termination is already available to Australian women.

And medical terminations are also being performed in Australia under a legal loophole allowing doctors to prescribe medications outside their specified purpose if their patients agree.

Doctors say an anti-inflammatory and anti-cancer drug known as methotrexate can also induce abortion.

Prof de Costa concedes some deaths have been linked with medical abortions overseas.

"In the US, since 2000, there has been one death from an undiagnosed ruptured ectopic pregnancy, and another death from myocardial infarction in a women with known heart disease who may have been more suited to surgical termination," she wrote in the MJA.

"While not diminishing the tragedy of any death, neither of these was directly related to the use of mifepristone (RU486).

"Also, in the past five years, there have been four deaths in the US, all in California, from post-abortion sepsis.

"These deaths - four in close to 400,000 abortions in the US - must be seen in the context of overall maternal mortality figures, currently around 12 per 100,000 births in the US.

"Pregnancy is never without risk for any woman, but both surgical and medical abortion carry less than 10 per cent of the risk of mortality when compared with continuing the pregnancy."

Under Australian laws, RU486 has only been available through federal drug regulator, the Therapeutic Goods Administration (TGA), with written permission from the federal health minister.

However, a bill that has now passed both houses of parliament means the minister has been stripped of his exclusive control over the drug and his powers given to the TGA.

- AAP