Mifepristone is safe and reliable, so why the ban?

Australian authorities have had little success in keeping illicit drugs such as heroin and ecstasy out of the country, but a pharmaceutical providing a safe alternative to surgical abortion has been successfully deemed contraband. The importation of mifepristone, or RU486 as it was previously known, is a designated restricted and may not even be evaluated or listed without the prior written approval of the (relevant) minister.

The circumstances around the introduction of what is effectively a ban on the introduction of mifepristone or any other medicines that could be used as abortifacients, is a prime example of how opposition to a woman’s right to privacy and choice harms individual health, public health, scientific research and medical advances.

Women in France, New Zealand, Sweden, the United States and Great Britain have access to mifepristone but Australian women are denied that choice thanks to the efforts of former conservative Tasmanian Senator Brian Harradine. In 1996 he, and other anti-abortion crusaders in the Federal Parliament, managed to persuade those in the two major parties to specifically ban mifepristone, using spurious heath risk arguments.

Even then, mifepristone had been safely used in France for a decade. It works by blocking progesterone - a hormone necessary for the establishment and maintenance of pregnancy. Prior to and since its introduction, in an attempt to scare women and restrict access to the medication, anti-choice forces have made unfounded claims that mifepristone endangers the lives and health of women. Yet the evidence clearly shows that mifepristone is safer than the already safe surgical abortion procedure, and both are more than 12 times safer than carrying a pregnancy to full term and birth.

Medical, as opposed to surgical abortion, is preferred by many women overseas because, as well as being safe, it is non-invasive, avoids surgical and anaesthetic risks and can occur very early in pregnancy. It is also more private, less costly and experience overseas shows it would likely replace 50 per cent of the surgical abortions currently being conducted here. It would be particularly useful for the many women in rural areas where terminations are no longer provided by GPs or hospitals.

The World Health Organisation,the Australian Medical Association, the Royal Australian College of Obstetricians and Gynaecologists and the Public Health Association of Australia all now agree that mifepristone should be made available under medical supervision. The Royal College of Obstetricians and Gynaecologists in the United Kingdom recommend the non-surgical in preference to surgical abortion for women with pregnancies of 49 days or less.

The Health Minister says the risk is that the termination may take place at home. Of course. This is the advantage of a medical abortion and, provided there is access to emergency care in the rare event of complications, this is perfectly safe. The vast majority of women who use this process for early pregnancy termination will not see products of conception because they are so small and passed along with accompanying blood loss.

Women who have medical terminations will experience bleeding, and often nausea, cramping, vomiting and so on. But more than 99 per cent of women using mifepristone do not report any adverse drug reaction. In fact reactions to drugs, such as over-the-counter pain relief medicines, like Tylenol are hundreds of times more common than are problems with mifepristone.

Anti-reproductive choice, high moral ground defenders of religious views on the matter of abortion, held sway in the federal parliament in 1996 and probably still does but it ought to be increasingly difficult to defend the RU486 ban when abortion is legal in Australia and after two million women worldwide have now used this alternative safely and effectively.

We can expect the anti-choice movement to use lies and half truths and purport to be protecting the welfare of women if their aim is to stop abortion. Some even argue that access to mifepristone would make it “too easy” for women and increase overall numbers of abortions. Experience overseas is that the availability of mifepristone made no difference to termination rates.

Should it seem as if the government is moving towards letting women have this choice, there will undoubtedly be calls to impose onerous and medically unnecessary restrictions on mifepristone’s availability in an attempt to make it virtually impossible for any doctor to actually prescribe the drug.

When mifepristone was being considered for use in the United States, there were demands for a registry of doctors who were prescribing the drug, specialised training and special conditions on the facilities in which the drug could be administered. While none of these were implemented at the time, there have been ongoing political attempts to introduce these excessive limits on the use of mifepristone. Given Australian anti-choice advocates' inclination to follow the well-worn paths of their US counterparts, we are likely to see the same tired suggestions here.

While this ideological battle is going on there is another whole group of people whose lives and health could potentially be greatly improved by access to this banned pharmaceutical. Mifepristone can help to induce labour and treat medical conditions such as infertility, endometriosis and certain types of tumours.

Numerous clinical studies and international research shows mifepristone is a promising and viable treatment option for meningioma, some breast cancers, fibroid tumours and uterine and ovarian cancers.

Researchers have also suggested that mifepristone might be useful in treating psychotic depression, HIV, Cushing’s disease and glaucoma.

Physicians can apply to the Minister for Health and Ageing for an exemption to the ban, and arrange the importation themselves if the minister agrees. But this process takes a very long time - time that people in these circumstances often cannot afford.

And of course research into other beneficial uses of mifepristone is inhibited by the lack of access to the drug in Australia.

The recent urging of all the reproductive health medical bodies for this restriction to be lifted has given us hope that the government might have a more open mind on the question. It was encouraging that Parliamentary Secretary Chris Pyne, who is responsible for the Therapeutic Goods Administration, said applications for exemption from the restriction would be considered on their merits.

Doctors, including Professor Caroline de Costa who sparked the debate with her recent article in the Medical Journal of Australia, and family planning groups are now busy preparing applications and hoping to set a precedent that will open the way for a sponsoring body or pharmaceutical company to import the product into Australia.

Mifepristone is safe, has been thoroughly tested, has a long history of successful use and shows potential for other applications. Adhering to a decision a decade ago which was made essentially on religious grounds is certainly no longer tenable.

With the government needing every Coalition vote to get its controversial IR and anti-terror laws passed, let’s hope that political expediency and trade-off do not compromise women’s health.