You’ve heard of Plan B? Now there’s Plan C
With restrictions on medical abortion in the United States, is there another way?
“Abortion by Mail” was the name of a provocative cover story in the Aug. 31 issue of the New York Times Magazine. The article describes efforts by reproductive rights activists to create “virtual clinics” by making the abortion inducing drugs mifepristone and misoprostol available via the Internet to poor women in countries that restrict access to the drugs. The article features the organization Women on Web, which it describes as a “’telemedicine support service’ for women around the world who are seeking medical abortions.” This service will not, however, be available to women in the United States.
Women on Web receives the drugs at cost from the Indian drug company Kale Impex, and asks women for a donation of 90 euros (about $116 at current exchange rates) to pay for the medicines, staff salaries, and other expenses; if the woman cannot afford to pay, the organization will send it anyway. It won't deliver to women in the U.S. because, unlike unlike many in other countries, safe abortion is technically available here, and mifepristone and misoprostol are both approved by the Food and Drug Administration.
Despite growing numbers of desperate pleas, Women on Web founder Rebecca Gomperts is firm about her refusal to serve women in the U.S. While sympathetic to the plight of American women who lacked access to safe abortions, she said: “I think this is a problem the U.S. has to solve itself. There are so many resources, so much money available there for abortion rights groups, I think they should be able to work on this. Starting on paper, with changing the laws.”
The FDA approved mifepristone in 2000, under the trade name RU-486, after years of efforts by abortion opponents to keep the drug out the United States. The agency imposed strict limitations: Only doctors who meet certain qualifications may dispense the drug, and women must take it in a doctor’s office. The drug is not available in pharmacies or online.
Misoprostol has fewer restrictions but is only available by prescription. In the U.S., misoprostol is usually used to prevent ulcers. When used for medical abortion, it is usually administered together with mifepristone. But studies have found that misoprostol is 75 percent effective if taken alone. This fact has led some abortion rights activists to use the battle for over-the-counter emergency contraception as a model for making misoprostol available without a prescription. In an article for RH Reality Check, Francine Coeytaux and Victoria Nichols refer to misoprostol as “Plan C” – a direct reference to the emergency contraceptive product Plan B. As I describe in my book, The Morning After, Coeytaux was one of the leaders in the effort to bring emergency contraception from “secret to shelf.”
Coeytaux and Nichols liken their "Plan C" to a form of menstrual regulation developed by self-help health feminists during the 1970s. The technique was called menstrual extraction and used a homemade suction device to remove menstrual blood and tissue after a missed period.
The procedure did not catch on in the U.S. but it did in some other countries, such as Bangladesh where “menstrual regulation” in the form of menstrual extraction “was a way for the government to meet women’s health needs, all the while steering clear of the controversial abortion debate.” Although abortion is illegal in Bangladesh except in cases where the mother’s life is at risk, menstrual regulation is legal if performed during the first trimester. Women do not have to have a pregnancy test before having the procedure and practitioners do not ask them if they are pregnant.
Coeytaux and Nichols ask, “Could misoprostol be accepted [and even marketed] in the United States as a drug for menstrual regulation”? Already American women are crossing the border into Mexico to buy misoprostol, where the drug is available over-the-counter for treatment of ulcers, to “bring down their periods (bajar la regla).” If misoprostol was available without prescription in the U.S., say Coeytaux and Nichols, “that would make it a true plan C.”
Use of various drugs for “menstrual regulation” is not new: In her book Devices and Desires, Andrea Tone describes how various over-the-counter contraceptives and abortifacients were marketed under the euphemism “female hygiene” in order to skirt censorship laws in the United States during the late 19th and early 20th centuries. Tone rightly observes that this “over-the-counter revolution” created products that were less expensive than diaphragms and put “women in charge of their reproductive destinies.” However, she downplays the health risks of products that, since they were available without prescription lacked serious scrutiny by the FDA. In other words, although women gained some measure of reproductive control, they were still at the mercy of an unregulated marketplace.
If misoprostol becomes a nonprescription drug, it will have to first go through the same arduous FDA approval as over-the-counter emergency contraception. Getting Plan B on the shelf alongside condoms and lubricants took two decades. Misoprostol will be a tougher sell because, the euphemism “menstrual regulation” aside, it is clearly meant to induce abortion. Also, as I mentioned in an earlier post on Plan B, making a drug available over the counter doesn’t necessarily make it affordable. This doesn’t mean that reproductive rights activists shouldn’t explore a “Plan C” for women who need it. We do need to recognize, however, that the move from prescription to over-the-counter is just one step in the process.
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