After-The-fact

By John Langone

For generations, pregnant women have dosed themselves with unpalatable, hazardous potions in desperate, largely unsuccessful efforts to rid their bodies of unwanted fetuses. Among the dubious household remedies: swallowing narcotics made from hempseed, douching with the caustic disinfectant potassium permanganate, and even quaffing gin laced with iron filings. Such medieval measures are now giving way to a modern alternative: drugs that can induce abortion. Approved in pill form abroad, they appear to have what their noxious predecessors lacked: safety and efficacy. They are not, however, lacking in controversy.

China and France last month became the first nations to sanction the use of one such preparation, the French-made abortion pill called RU 486 (trade name Mifepristone). Antiabortionists in the U.S. and abroad lost no time protesting. The Washington-based National Right to Life Committee last week threatened to boycott products of any U.S. firm that attempts to market such pills. The group's ire was further raised when the New England Journal of Medicine last week gave high marks to another abortion drug, epostane, developed by Sterling Drug Inc. "These pills kill unborn babies," said committee spokesman Richard Glasow. "They will increase the use of abortion as a method of birth control."

The two drugs act in a similar manner, by interfering with the hormone progesterone, which maintains a proper uterine environment for pregnancy. Epostane prevents the ovaries from making progesterone; RU 486 blocks the hormone's activity. In both cases, the uterine lining sloughs off and the embryo is expelled.

Studies of RU 486, which was first incorrectly dubbed the "morning-after pill" when it was discovered in 1982 by French researcher Etienne Beaulieu, . have found it to be effective 95% of the time when taken during the first five weeks of pregnancy in conjunction with a prostaglandin, a substance that causes the uterus to contract. According to last week's Journal, Dutch researchers found epostane to be 84% effective in women five to eight weeks pregnant. Suction abortions, the usual surgical method, have a 96%-98% success rate. While both drugs allow women to avoid the dangers of surgery and anesthesia, they do carry a small risk of causing excessive bleeding. Should they fail, surgical abortion would be urged, since the drugs could damage the surviving fetus.

The French and Chinese have proceeded cautiously in approving the abortion pill. Both countries require that it be administered in a clinic or hospital rather than at home. To prevent casual use, the French have made it no less expensive than a surgical abortion (cost: upwards of $130). The Netherlands and England are considering approval of RU 486. Meanwhile, Roussel Uclaf, its manufacturer, has contracted with the World Health Organization to distribute the pill at low cost in developing countries.

Whether such pills will ever be approved in the U.S. remains in question. The National Institutes of Health says it is investigating RU 486. Last week Gynopharma, Inc., of Somerville, N.J., which markets the only IUD still sold in the U.S., quashed a rumor that it is seeking federal permission to market the drug. Such speculation, said spokeswoman Cecilia Pineda, probably reflected "our reputation for taking on situations where there are risks." Apparently, even a risk-taking corporation is unwilling to gamble with the formidable wrath -- and boycotting power -- of the U.S. right-to-life lobby.

With reporting by Margot Hornblower/Paris