After winning a 12-year battle to legalize RU-486, local abortion-rights advocates now disagree about how dramatically the drug will change the nature of abortion in the United States.
Some predict that the pill, which is expected to be available in about a month, will revolutionize the abortion debate by making the procedure a much more private matter and by encouraging more physicians to offer it.
Others suggest that the restrictive conditions imposed on the pill by the Food and Drug Administration will ensure that most women continue to obtain abortions in clinics and hospitals, as they do now.
Virginia medical researchers, meanwhile, look forward to a little-known side effect of legalizing Mifeprex, as the abortion pill will be known: the prospect of using small doses of the drug to treat a variety of illnesses, such as certain types of inoperable brain tumors, breast cancers and other diseases related to hormone levels.
"This certainly is a milestone for women and for people involved in providing health care for women," says Grace Sparks, president of the Virginia League of Planned Parenthood. "It's going to make abortion much more available."
About eight out of 10 counties in America have no abortion providers, Sparks says. The anonymity of prescribing a pill like Mifeprex may encourage more doctors to offer it. Studies of abortion pills in Europe, however, have not shown an increase in the total number of abortions, she says.
A survey in the summer 2000 issue of the Journal of the American Medical Women's Association found that 54 percent of obstetricians describe themselves as likely to prescribe Mifeprex for abortion, including 35 percent of those who do not now perform the surgeries.
But many doctors are reluctant to even discuss the possibility for fear of a backlash. None of the more than half a dozen gynecologists contacted for this story would agree to talk.
When approving the abortion pill, known chemically as mifepristone, the FDA imposed a number of restrictions.
Mifeprex, which may be used only until the seventh week of pregnancy, will be distributed only to physicians who can accurately determine the duration of a patient's pregnancy and detect an ectopic, or tubal, pregnancy.
Physicians who prescribe Mifeprex also must be able to provide surgical intervention in case of incomplete abortion or severe bleeding, or have made advance plans to provide such care through others.
Patients must be given a detailed medical guide.
Women, also, may not take the drug if they are using an intrauterine device for birth control or if they have certain health problems, such as a suspected ectopic pregnancy, chronic failure of the adrenal glands, current long-term therapy with corticosteroids or bleeding disorders, or if they are allergic to the drugs involved.
Using Mifeprex is much more involved than simply popping a pill to make a pregnancy disappear.
A woman at the doctor's office begins the process of abortion by taking three 200-milligram pills of mifepristone. That blocks the hormone progesterone, causing lining of the uterus to thin and prevent an embryo from remaining implanted, according to the FDA. Two days later, the woman takes two 200-microgram pills of misoprostol, which causes contractions, bleeding and cramping and expels the embryo in a process somewhat like a miscarriage.
This process can occur at home or in a doctor's office.
Although the embryo is typically expelled a few hours after taking the second set of pills, some bleeding and spotting may last nine to 16 days.
Women return to the doctor 14 days after taking the first pill to determine whether the pregnancy has been terminated. In a small number of cases, doctors will have to perform surgical abortion to terminate pregnancies not aborted by the drugs. In about one of 100 women, bleeding can be so heavy that a surgical procedure is required to stop it.
That worries anti-abortion activists like Michael Stone, coordinator of the Respect Life campaign of the Catholic Diocese of Richmond. Abortion opponents view the embryo as a complete human being, even in the early stages of pregnancy.
"The church of course is opposed to abortion in any form," Stone says. "We're very concerned about this hitting the market. There have been a number of health-related concerns with RU-486 in Europe. If they (Europeans) have universal health coverage and they have problems, here where so many people are uncovered there's even more concerns for the health of women."
Stone rejects the idea that Mifeprex would make abortion more private and convenient for women, as some have proposed.
"If anything, this is much more burdensome because it requires more office visits," he says. "It requires the stillbirth in their home of the fetus. I fear this is going to be far more traumatic for some women."
But outside the abortion debate, Virginia researchers say it also may prove to be a wonder drug for a wide variety of serious illnesses.
In smaller amounts, Mifeprex which belongs to a class of drugs known as an antiprogestins may hold out hope for many sick people, says reproductive scientist Robert F. Williams, a professor of obstetrics and gynecology at The Jones Institute for Reproductive Medicine at Eastern Virginia Medical School in Norfolk.
Scientists and drug companies have been reluctant to produce the drugs, however, for fear of stirring up controversy. The FDA's action last week may encourage companies to begin developing antiprogestins for nonabortion uses, Williams says.
Antiprogestins may be able to slow the growth of certain types of breast cancer as well as cancers of the lining of the uterus. They show promise in treating meningiomas, cancers that attack the membranes around the brain. They seem to help people suffering from autoimmune diseases. The drugs also have been found useful in treating endometriosis and to relieve the breakthrough bleeding that is a side effect of some menopause medications and birth control pills.
Antiprogestins dilate the cervix during childbirth, which can help reduce the need for Caesarean sections. The chemicals also help treat Cushing's syndrome, a metabolic disorder caused by too much production of the hormone cortisol.
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