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Abortion access

Non-surgical, medically induced, abortions
using methotrexate and misoprostol

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Overview:

Medically induced abortions involve the use of a medication instead of surgical techniques.

bulletRU-486 is one medication that is used; it is described in a separate essay.
bulletThis essay deals with abortions induced by a combination of methotrexate and misoprostol.

Religious and social conservatives often refer to medical abortions as "chemical abortions."

Abortions have traditionally involved surgery, clinics, hospitals, insurance companies, instruments, anesthetics, etc. But two recent medical developments may change this in the near future for many women:

bulletThe home-pregnancy kits that are now available are simple to use and rather reliable. They can be purchased at relatively low cost in most drug stores. They allow accurate detection of pregnancy at or a few days before the expected timing of the first missed period. Thus, a woman can often detect a pregnancy within two weeks of conception
bulletA combination of two drugs (methotrexate and misoprostol) will usually terminate the pregnancy if given at 7 weeks or less after conception.

Methotrexate is approved by the FDA as an anti-cancer and immune modulator drug. Misoprostol is used to prevent ulcers in patients treated with nonsteroidal antiinflammatory drugs. In 2000-OCT, the manufacturer of misoprostol sent a circular letter which mentioned that the FDA had not approved its use on pregnant women. 16 However, the FDA allows physicians to employ these drugs to induce an abortion, even though that was not their original intent. Obstetricians have used the drug since 1988 to terminate ectopic pregnancies. (Ectopic pregnancies occur when the fertilized ovum lodges in the fallopian tubes. They are sometimes called "tubal pregnancies." If untreated, they are generally life threatening.) 6

An office of Planned Parenthood reports that "More that 3,000 women have used this method in clinical trials, clinics, and doctors' offices, and there have been no reports of significant side-effects or long-term risks." 5

A woman who has had unprotected sex can check whether she is pregnant within two weeks of the possible conception, and terminate any pregnancy immediately with help from any cooperating physician. One physician refers to these as "Early Medical Abortions (6-7 weeks) Option using Methotrexate and Misoprostol." 4

Three women from Seattle who have had medical abortions describe their experience in Reference 13.

In late 1999-DEC, Rhode Island became the last state to pass legislation that approves of the use of Methotrexate & Misoprostol. The treatment is thus legally available across the country. 

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What a medical abortion involves:

Methotrexate has been available for almost 50 years as a treatment for tumors, arthritis, and psoriasis. It is given by injection. Normal side effects are described as "usually mild" and not of long duration; they can include: nausea, diarrhea, abdominal cramping, hot flashes, or sores in the mouth. The medication stops the development of the embryo.

Misoprostol is a commonly used prostaglandin medication for ulcers. It is inserted into the vagina, often by the woman at home, 5 to 7 days after the injection of methotrexate. A number of side-effects are possible, including nausea, vomiting, diarrhea, abdominal pain, dizziness, and/or fever and chills.

Methotrexate prevents the cells in the embryo from dividing. Misoprostol causes the womb to contract. Cramping and bleeding will be experienced. Blood clots will be passed. The embryo is usually expelled within a week. If the woman has determined that she is pregnant 2 weeks after conception, and goes immediately to her doctor for the injection, then the development of the embryo might be stopped at 2 weeks, when it is an small piece of undifferentiated tissue. At 3 weeks, it is typically 1/12" (2 mm) long, the size of a pencil point. It most closely resembles a worm; it is long and thin and with a segmented end. A week later, it is typically about 1/5" (5 mm) long. It looks something like a tadpole. The structure that will develop into a head is visible, as is a noticeable tail. The embryo has structures like the gills of a fish in the area that will later develop into a throat.

One complication of this procedure is that it is only about 95% reliable; the embryo is sometimes not expelled, but continues to grow. Because of the nature of the medication used, it will be almost certainly seriously deformed. Before proceeding with a medical abortion, the woman should be willing to follow up with a surgical abortion if the chemical technique fails. One study expresses concern that a small percentage of women may change their mind and not follow through with a surgical abortion in the event that a medical abortion fails. Very serious limb damage in the newborn will result. 3

Planned Parenthood reports: "The most common complication of a medical abortion, like the most common complication of miscarriage, is heavy bleeding. A small number of women may even need an emergency D&C to stop the bleeding. In very rare cases, a woman may need a blood transfusion." 5

Published studies by other medical researchers have found that using methotrexate and misoprostol in terminating pregnancies is approximately 90% effective when it is taken up to 49 days from the first day of a woman's last menstrual period.

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Results of a Clinical Trial:

Richard U. Hausknecht reported the results of a study at Mount Sinai School of Medicine, New York, NY.

"A total of 171 of the 178 women enrolled in the study (96 percent) had successful medical abortions. Twenty-five women (14 percent) did not have an abortion after the first dose of misoprostol and received a second dose. Eighteen subsequently had complete abortions, but seven required suction curettage. In all seven women who required suction curettage, there was histologic evidence of disruption in the conceptus. No important side effects or complications were noted."

A second study by Dr. Eric Schaff was held at the University of Rochester. They "found that 98 of 100 women completed abortions with the Methotrexate-Misoprostol combination". 9

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Some advantages/disadvantages to medical abortions:

When compared to other methods, advantages include:

bulletNo surgical instruments are used. Many women consider the procedure less invasive.
bulletNo anesthetics are required.
bulletThe procedure can be done in a physician's office. This may offer the woman more privacy, and less exposure to demonstrators, when compared to a trip to an abortion clinic.

Disadvantages include:

bulletAt least two visits to a physician are required (vs. one for an abortion by vacuum aspiration)
bulletThe medication is only about 95% effective.
bulletThe duration of the procedure and its related bleeding are greater.
bulletThe woman may be distressed at seeing the expelled embryo. 8 

One source predicts that the Methotrexate/Misoprostol combination will be eventually replaced with a Mifepristone (RU486)/Misoprostol procedure when RU486 is finally made available. The latter is faster, and has a proven safety history. "Over 200,000 women already have successfully used the Mifepristone regimen." 9 In Canada, a series of studies across the country started in mid-2000; both medications are being compared.

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Safety concerns raised by Pro-Life groups:

bulletAn article by Sue Widemark dated 1996-SEP-7 is available on the Catholic Information Network's web page.  She concludes that Methotrexate is a "rather dangerous drug according to the PDR (Physicians Desk Reference)." As the name implies, the book is consulted for drug information by many physicians. She correctly quotes the PDR:  that the medication should only be used to treat "severe, disabling, recalcitrant disease." However, she fails to note that these precautions refer to long term treatment of cancer or severe arthritis or psoriasis. When Methotrexate is used to induce an abortion, it is given in a single injection, and not repeated. 10
bulletDee Doughty, life resources director of Life Advocates in Houston TX said that her group strongly opposes clinical trials of what she refers to as "M&M's." She had two main concerns: psychological damage to women caused by the abortion, and possible negative long-term effects that the drugs may cause. 11
bulletSome concerns have been raised that Methotrexate might suppress the level of folic acid in the woman's body. She might become pregnant at a later time and her new fetus might be at risk of developing spina bifida. We obtained an opinion from the medical director of Planned Parenthood. He said that this concern has been well studied by several authors and there is no evidence of adverse effects in subsequent pregnancies after methotrexate abortion. 
bulletOlivia Gans, director of American Victims of Abortion (a unit of the National Right to Life Committee) was quoted by CNN as saying: "Methotrexate may cause serious complications for the mother and stops the beating heart of her unborn child...The combination of these two drugs [would have] a potentially fatal effect on unborn children and the women who take this drug combination."
bulletRev. Paul Marx, founder and chairman of Human Life International, referred to clinical trials of "chemical" abortions. He declared that "Planned Parenthood has declared chemical warfare on the unborn...Given Planned Parenthood's eugenic philosophy and tradition, it comes as no surprise that they would use methotrexate, the highly toxic drug used to treat cancer, to end a life of a child and pollute its mother's body. From the Planned Parenthood perspective, a baby IS a cancer." He referred to what he called Planned Parenthood's "callous disregard for life, for truth and for the health and welfare of women..." Rev. Marx predicted massive lawsuits against the abortion industry in the future.

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Misuse of misoprostol outside of North America:

In some countries, like Argentina, Brazil, Colombia, Dominican Republic, Indonesia, Nigeria, Philippines, Spain, South Africa, misoprostol is readily available on the black market. In most of these countries, women cannot obtain legal abortions. In desperation, they purchase the medication in order to terminate their pregnancies without medical help. Susheela Singh of the Alan Guttmacher Institute in New York has studied clandestine abortion practices in Latin America. She says: "It's really the poor person's method." The drug can cost as little as US$ 0.35 and can often be purchased over the counter without a prescription. Up to 75% of clandestine abortions in Brazil involve the medication. When misoprostol is taken in isolation, it only causes an abortion about 40% of the time. Studies have shown that in many cases, the pregnancy continues, and the baby is born with birth defects: fused joints, growth retardation and Möbius syndrome (paralysis of the face). 15

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Impact on the Pro-Life/Pro-Choice conflict:

This development has the potential of changing the pro-life/pro-choice debate forever. Methotrexate/Misoprostol, and/or the Mifepristone (RU486)/Misoprostol combination will probably become widely used in North American. Abortion will eventually become a very private act in North America, between a woman and her physician. It has become so in many European countries. Pregnancies can be terminated when the fetus is only a small speck; a piece of undifferentiated tissue.

This method is almost immune to attack by pro-live advocates. They will be faced with picketing every physician's office rather than a relatively small number of abortion clinics. Pro-life groups will no longer be able to target those few physicians who performed abortions in the past, because any doctor may choose to prescribe these pills. This abortion method has the potential to drastically reduce both the number of surgical abortions and the number of clinics that perform them.

One source indicated that a pro-life group has sent threatening faxes to medical abortion researchers and have picketed their officers. 1 But that seems to be the only options open to them. 

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References used:

  1. Elinor Burkett, "The Right Women: A Journey Through the Heart of Conservative America" Simon & Schuster (1998) You can read reviews of this book and/or safely order it from the Amazon.com online bookstore  
  2. Excerpt reprinted in the Utne Reader, as "The Last Abortion", 1998-MAY/JUN, Page 80, 81, 109 & 110.
  3. L.E. Ferris, A.S.H. Basinski, "Medical abortion: What does the research tell us?," Canadian Medical Association Journal 1996; 154: Pages 185-187. Available at: http://www.cma.ca/cmaj/vol%2D154/0185e.htm
  4. R. B. Whitney, M.D. at: http://www.drwhitney.com/
  5. FactSheet, "Medical abortion using methotrexate and misoprostol," Planned Parenthood of the Columbia/Willamette home page, Portland OR, at: http://www.ppcw.org/
  6. "Non-Surgical Abortion Procedures," Reproductive Health & Rights Center, at: http://www.choice.org/
  7. Richard U. Hausknecht, "Methotrexate and Misoprostol to Terminate Early Pregnancy," The New England Journal of Medicine, 1995-AUG-31, Vol.333, No. 9
  8. "First Trimester Abortion Options," The Reproductive Rights Network/Boston at: www.abortionaccess.org
  9. "Methotrexate May Offer New Abortion Method," Feminist Majority Foundation, at: http://www.feminist.org/
  10. Sue Widemark, "The Cancer Meds for Abortion - Is it a Safe Abortion?," Catholic Information Network at: http://www.cin.org/
  11. Ron Nissimov, "Cancer drug to be tested in abortions," Houston Chronicle, Houston TX, 1997-JAN-2
  12. "Planned Parenthood to test drug-induced abortions," CNN Interactive, 1996-SEP-12, at: http://www.cnn.com/
  13. Stephanie Thomson, "3 women and their nonsurgical abortions," Seattle Times, Seattle WA, 1996-SEP-18, http://www.seattletimes.com/
  14.  Babies," Human Life International, at: http://www.hli.org/, 1996-MAR-29
  15. Sylvia Pagán Westphal, "Birth defects caused by ulcer drug abortions," NewScientist.com, at: http://www.newscientist.com/
  16. "Misoprostol not FDA approved for use on pregnant women," Covenant News, 2000-OCT-13 at: http://www.covenantnews.com/

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Site navigation: Home page > "Hot" topics > Abortion > Facts > here

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Copyright © 1999 to 2004 incl., by Ontario Consultants on Religious Tolerance
Latest update: 2004-MAR-10
Author: B.A. Robinson

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