Do-it-yourself death

Most everyone knows that the coming to America of RU-486 later this year will change the abortion industry. What's being missed is that RU-486 will change dramatically abortion's psychological effect on women.

Vicki Thorn, executive director of the National Office of Post Abortion Reconciliation and Healing, a clearinghouse for post-abortion research and information, says that a woman's home, where the abortion will take place about half the time, is likely to become an aversive place to her, just as many women avoid passing by abortion clinics after their abortions.

Women who go out of their way to avoid traveling past a particular abortion clinic will find it difficult to avoid their own homes. And the fact that RU-486 is self-administered will make matters worse, Ms. Thorn says. "We're going to have women having acute reactions," she believes, because of the compounded feelings of guilt that will come from having been the direct hand behind the abortion.

When the Food and Drug Administration gave its approval to RU-486 last September, these considerations were lost in the rush to satisfy radical women's groups and the Clinton administration, which had pushed for approval for years. Supporters lauded the decision, saying it would make abortion more private and less intrusive for women, who will be able to get the drugs at their doctors' offices instead of running the gantlet of protesters at abortion businesses.

Supporters say the drug will assure women's continued access to abortion. They look at surveys that show many doctors who won't physically perform abortions happily prescribing a drug that will accomplish the deed. Since the single biggest threat to widespread abortion is the lack of doctors willing to do them, supporters of RU-486 see the drug playing a crucial role in keeping abortions widely available in all parts of the country.

Supporters also like the drug's "efficiency": It causes nausea, vomiting, bleeding, and cramping, but clinical trials on 2,000 women throughout the United States showed that 95 percent of the time the unborn baby dies. (In the other 5 percent of cases, pregnant women go for follow-up surgical abortions.)

It is too soon to tell what all the consequences of RU-486 will be. Post-abortion experts are learning more about the drug as they gear up to help a new generation of women who will need to piece together a life after abortion.

They are learning that RU-486 actually involves two drugs. During her first visit to the doctor, a woman takes two tablets of mifepristone, which suppresses the production of progesterone necessary to maintain the pregnancy. Two days later, she must return to the doctor and take three tablets of a prostaglandin, which causes uterine contractions.

About half of the women expel the tiny baby-RU-486 can only be used during the first 7 weeks of pregnancy when the baby is about 1/3 of an inch long, with beating heart and arms and legs-within 4 hours of taking the prostaglandin. More than a third will expel the baby during the first day, probably at home. And about a tenth will wait more than 24 hours to complete the abortion that started 3 days earlier.

The procedure is so grueling that only 20 percent of women seeking abortions in France get a chemical one, even though RU-486 has been available there since 1988 and the price is comparable to a surgical abortion.

RU-486's problems concern even some advocates of legal abortions. Ava Torre-Bueno, a pro-choice therapist and former Planned Parenthood abortion counselor in San Diego, says, "I can't imagine doing RU-486. The dragging out of this thing seems so awful to me."

Abortion counselors are realizing that the problem will be even worse if a woman changes her mind after taking the required first drug, but before taking the second one necessary to complete the abortion. "That's going to be hell," Ms. Torre-Bueno says.