The wait is over," declares the Web site of Danco Laboratories, a small, secretive company that is the sole American distributor of a drug called Mifeprex. Mifeprex is the trade name for mifepristone, better known as RU-486, the so-called abortion pill that received FDA approval last fall. That's right, that pill -- the pill that enables a woman to abort a pregnancy during the very early weeks; the pill that was available in France years before it came to market here; the pill that opponents fear will make abortion more prevalent, while supporters hope it will make abortion both more accessible and more invisible. The pill whose approval was hailed by Gloria Feldt, president of Planned
Parenthood, as a "historic moment, comparable to the arrival of the birth control pill 40 years ago." The tiny little thing that people hope -- or fear -- may change the abortion debate, calming the doubts of Americans who, typically, have fewer problems with abortion the earlier it's performed.
But as it turns out, the wait isn't quite over.
Not in Washington, anyway.
As of this writing -- eight months after approval, and six months after Danco began shipping pills -- a woman still cannot obtain RU-486 from any Planned Parenthood clinic in D.C. or its suburbs. Instead, callers are directed to a National Abortion Federation hot line, which tells them that the nearest NAF-member clinic offering it is in Baltimore.
A woman cannot obtain it from Hillcrest Women's Surgi-Center, a longtime D.C. abortion provider. "I don't think we're going to have it," a staffer says.
She cannot obtain it from Women's Health Clinic in Alexandria. Or Women's Health Care and Surgi-Center in Clinton. Or Potomac Family Planning Center in Rockville and D.C., which touts the "abortion pill" in a big Yellow Pages display ad but does not, in fact, offer it. "We were all set to get it," a staffer explains, "and the doctor decided against it."
In many ways, this is more surprising than the fact that a woman still cannot obtain RU-486 from many local doctors who normally might be sympathetic. At one time, the most ambitious argument for RU-486 was that it would move abortion away from clinics (and clinic protesters) and into the offices of more private OB-GYNs and family practitioners. But there have been signs all along that this is not likely: In a survey conducted by the Kaiser Family Foundation, doctors tended to be less willing to administer RU-486 the more they knew about it. Their concerns weren't so much medical as procedural. Because RU-486 fails to work in a tiny fraction of cases, doctors who offer it also must be able to provide a surgical abortion or be affiliated with a doctor who can. And they must purchase the drug up front. "I have to buy it without knowing whether I'll be reimbursed," says one local OB-GYN, Ellen Whitaker, who is still unsure whether to invest nearly $300 in a single three-pill dose, considering that no patient has asked her for it. Qualms like this lead Kaiser's
Tina Hoff to predict that RU-486, rather than transforming the place where abortion happens, will be one more option
offered in a traditional clinic setting.
And what about those clinics? To me, this was much more unexpected: that more than half the D.C.-area clinics I called do not offer it, and that many do not plan to. Clinics are veterans of the abortion wars; they know about counseling and billing. "We didn't anticipate that it would take quite this long to put everything in place," says Maxine Klane, vice president for patient services for Planned Parenthood of Metropolitan Washington, who says that Mifeprex will be offered locally within the month. Up to now, she says, the time has been spent training counselors, adding staff, producing printed material in English and Spanish. "We want to do this the right way," she says.
Nationally, the hunt may continue to be daunting. To date only 83 of Planned Parenthood's 900 health centers offer RU-486. A pill-induced abortion requires three doctor's visits over two weeks. For women who work, or take care of a family, or both, calling around or driving from town to town discourages ease of access, which was part of the supposed advantage.
What to make of this scarcity? Is the drug more cumbersome to administer than advertised? Or is it so expensive (at almost $600, the entire procedure is twice the price of a surgical abortion) and time-consuming that women are not in truth clamoring for it? Are today's culture warriors out of touch with the view from the street?
Yes, I'd say, and yes and yes. It would be wrong to expect RU-486, alone, to transform the way abortion is regarded or delivered. But it would also be wrong to lay responsibility for that (as proponents are apt to do) solely at the feet of the political right -- which, it's true, worked hard to bar the approval of RU-486 and, once it was approved, cast a needless cloud over its safety. It seems odd that those who clamored loudest for its approval have been so slow to offer it. RU-486 might have been a little more historic if, from the get-go,
it had been a little more available.
Liza Mundy's e-mail address is mundyl@washpost.com.