Echo Issue Outline: copyright Echo Education Services
First published in The Echo news digest and newspaper sources index.

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Issue outline by J M McInerney

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Should `abortion pills' such as RU 486 be trialed and made more readily available in Australia?
On the evening of May 21, the Senate passed a private members bill, the Therapeutic Goods Amendment Bill.
The Bill lists abortion drugs as restricted goods and gives the responsiblity for granting import exemptions exclusively to the federal Health Minister.
Critics of the bill have claimed that its effect will be to deny, or at the very least limit, Australian women's access to abortion-inducing drugs such as RU 486.

Background
RU 486, or mifepristone, is a French drug that blocks progesterone, which is essential to maintain pregnancy.
RU 486 has been used in France and China, since 1988, in England, Wales and Scotland, since 1991, and in Sweden, since 1992. It is also used in parts of India. The drug is about to be manufactured in the United States.
As RU 486 is not manufactured in Australia, supplies are only available through importation. The effect of Senator Harradine's bill will be to significantly reduce the ease with which RU 486 and similar drugs can be brought into Australia.
Trials of RU 486 have been conducted in Australia under the auspices of the United Nations' World Health Organisation (WHO).
These trials were conducted in 1994 and 1995. They involved 260 Australian women.
Australia was one of 20 nations which participated in the trials.
The purpose of the trials was to determine the effectiveness of RU 486 at lower dosages than are usually prescribed.
The reason for testing the effectiveness of lower dosages is that it is hoped that the drug can be used to control the population growth of Third World countries.
For use in Third World countries, lower dosages would mean lower costs and this would be a significant advantage.
The Australian trials were halted for a period in 1994 by the former federal Health Minister, Dr Carmen Lawrence. The trials were temporarily stopped after Right to Life and Roman Catholic groups questioned the research protocols.
An independent inquiry allowed the trials to continue.
RU 486 is regarded as both an `emergency contraceptive' and an abortion agent.
It is termed an emergency contraceptive when it is used soon after unprotected intercourse. It can be used in this manner immediately after intercourse and up to a week later.
As an abortifacient (abortion inducing substance or device), RU 486 can be used as soon as a period has been missed. It has also been used up to 38 weeks into a pregnancy to expel a dead foetus.
It is usually recommended that RU 486 be used in conjunction with prostaglandin tables, to be taken two days after the RU 486, if an abortion has not already occurred. The use of prostaglandin usually results in abortion within two or three hours.
Though RU 486 is probably the morning after pill of choice, there is a morning after pill currently in use in Australia which is simply a high dosage of the usual contraceptive pill. This procedure must be used within 12 to 72 hours of unprotected sex.
Another drug, methotrexate, has also been used as an abortifacient, within the United States.
It terminates pregnancy by dissolving rapidly growing tissue. Like RU 486, it is used in conjunction with prostaglandin. Unlike RU 486, methotrexate cannot be used as an emergency contraceptive.
It can be legally acquired within Australia as it is used in the treatment of cancer, psoriasis, arthritis and ectopic pregnancy. However, family planning centres are currently not planning to use it as an abortifacient because of a range of side-effects including cramping, headache, dizziness and nausea.

Arguments against RU 486 and similar drugs being tested or made more readily available in Australia
There are three primary sets of argument offered against drugs such as RU 486 being either tested or made readily available in Australia.
One of these sets of argument centres around the potential risk to the wellbeing of women who take the so-called `morning after' or `abortion pill'.
The second set of arguments opposes the pill on the grounds that it is an abortifacient. Those who object to the drug in these terms do so because of their opposition to abortion in any form.
The third set of arguments centres around which section of the community should decide the ease with which such drugs are either tested or used within Australia.
Firstly, those who object to abortion pills on the grounds that they can damage the women who use them, note that the drugs are not always effective and can require surgical abortion to be performed in the event of failure.
Dr Lynette Dumble, senior research fellow in the Department of Surgery at Melbourne University, has stated that RU 486 has a failure rate of 5 per cent and that in 60 per cent of these cases surgical abortion has then to be performed.
Those who are critical of the drug's effectiveness, and its impact on women who use it, claim that in the event of failure, having used RU 486 and then having to have recourse to surgical abortion is more distressing for the women concerned than simply having had a surgical abortion.
RU 486 has also been criticised because of the length of time it takes to work. Dr Dumble has claimed that the drug can take up to a week to bring about an abortion. Dr Dumble's view is `Women don't need to go through that. They are already traumatised enough.'
Dr Dumble has argued that the extent of use of RU 486 in France and the United Kingdom is not because the women in those countries find it satisfactory. Rather, Dr Dumble has claimed, RU 486 is used in France and the United Kingdom because surgical abortions are so difficult to acquire.
According to this line of argument the decision to use RU 486 in either France or the United Kingdom is a forced choice.
Dr Dumble has described RU 486 as `not private, not prompt and not perfect'.
Dr Renate Klein, a leading researcher at Deakin University's Australian Women's Research Centre, has criticised RU 486, claiming that its use requires up to five visits to a licensed abortion clinic, invasive examinations and several drugs.
Dr Klein has claimed, `Although I support a woman's right to safe and legal abortion with good counselling, I am emphatic that this dangerous, second-rate drug is not a positive addition to women's decision-making whether or not to have children.'
There are also those who claim that the drug can pose a risk to the health of the women who use it. Those who make this claim note that there appear to have been some maternal deaths associated with its use in France.
The drug is objected to on moral grounds by those opposed to abortion. It is claimed to be an abortifacient (a substance or device which induces an abortion) rather than a contraceptive (a substance or device which prevents conception taking place).
What is meant here is that the drug can prevent a fertilised ovum (egg) from successfully implanting in the wall of the uterus. Critics of abortion see the action of this drug as the destruction of a human life.
Those opposed to abortion believe it is not an issue which primarily involves a woman's right to control her own body.
Mr Andrew Bolt, a managing editor with the Herald Sun, has claimed that abortion is an issue that concerns all people, not just women unwillingly pregnant.
`Such matters of life and death ... are in some way ... [the] business [of men] too, either as fathers or simply fellow human beings,' Mr Bolt argues.
Those who hold this view usually argue that abortion is a matter of conflicting rights: a woman's right to control her own body, opposing the foetus' right to life. In this context, they argue, the foetus' right to life should take precedence.
This is the position adopted by the Catholic Church. Father Anthony Fisher, a bioethics lecturer with the Australian Catholic University, has stated that the Roman Catholic Church opposes RU 486 on moral grounds.
(Father Fisher also claimed that the Catholic Church was opposed to the use of RU 486 because there was evidence it had led to the death of some women and could rupture the uterus.)
Finally, there are those who argue that the decision as to whether substances such as RU 486 should be available should be made by the Health Minister and Parliament.
Independent Senator Harradine's private member's bill requires that drugs such as RU 486 be exempted from the restricted goods list only by the Health Minister and that any decisions regarding the importation of these drugs must be tabled in Parliament.
Senator Harradine supported his bill by claiming, `My simple point is these matters are too important to be left in the hands of science technologists ... It is the politicians who ultimately have got to wear the responsibility for the serious ill effects of such trials.'
(Senator Harradine was referring specifically to the World Health Organisation trials of RU 486 which occurred in Australia in 1994 and 1995. These trials occurred without formal government sanction. They initially went ahead on the approval of an official of the Therapeutic Goods Administration.)
According to Senator Harradine's line of argument, the Health Minister and Parliament should make such decisions as these people can be held accountable in a way that medical officials can not.
What is being argued here is that if a minister makes a serious error in allowing a particular substance into the country, he/ she can be called to account either through losing his/her ministerial post or at the ballot box.
Senator Harradine implies that it is far harder to hold medical researchers or public servants accountable for decisions they make.
Underlying Senator Harradine's argument appears to be the belief that the more directly a person can be made accountable for the consequences of any decision they take, the more responsible and cautious they are likely to be.

Arguments in favour of RU 486 and similar drugs being tested or made more readily available in Australia
There are three primary arguments offered in support of RU 486 being tested and made available to woman in Australia.
The first of these arguments is that RU 486 is an effective emergency contraceptive or abortifacient which poses no significant threat to the wellbeing of the women who use it.
On the question of its effectiveness, it has been claimed that RU 486's failure rate is no higher than that for surgical abortions - one in 500.
It has further been claimed that RU 486 poses no greater risk to maternal life than surgical abortion - one death in 500,000 users.
(Both these statistics have been cited by Professor David Healy, who sponsored World Health Organisation's trial of RU 486 in Australia.)
Regarding the supposed risks to maternal life which it has been suggested RU 486 poses, it has further been claimed that the three deaths sometimes attributed to the drug in France occurred in women with heart conditions and were in fact caused by the effect of prostaglandin.
On the question of the drug's effectiveness, it has been noted that the supposed waiting period of a week before the foetus is expelled is not usual. Rather, researchers have claimed, in one third of users abortion will have occurred between 12 and 48 hours of taking RU 486. For those for whom this is not the case, it is recommended they take an additional drug, prostaglandin, which will then trigger an abortion within two or three hours.
It has also been argued that the effectiveness and acceptability of RU 486 can be gauged by those women for whom it is the treatment of choice in countries where it is legally available.
It is claimed that only one third of women in Britain seeking an abortion choose a surgical method. Those who choose to use a chemical means of inducing abortion do so because they are said to want to avoid surgery and anaesthesia.
There are also those who have defended the use of RU 486 largely in terms of women's right to access to abortion.
Feminist, writer and newspaper columnist, Beatrice Faust, argues that Senator Harradine is trying via bureaucratic, parliamentary means to deny women access to a particular form of abortion.
Ms Faust notes that abortion is legally available in all Australian states and territories and then claims that Senator Harradine's intent is to use the Therapeutic Goods Act to limit the means by which a legally available procedure can be delivered.
Ms Faust states, `The amendment tries to control termination of pregnancy by bureaucratic means when criminal legislation has failed.'
Ms Faust then goes on to defend the right to abortion, claiming that early foetuses should not be regarded as human life.
Ms Faust contends, `Almost no one thinks that early foetuses are actually babies ...'
Ms Faust finally contends that the effect of the bill will not be to prevent abortions taking place, it will be to ensure that surgical abortions continue to occur at the current rate of some 75,000 a year.
Ms Faust asserts that Senator Harradine's bill `has condemned around 75,000 women to surgical intervention at considerably greater cost than RU 486 in dollars and stress.'
A similar point has been made by professor Healy, `There are about 75,000 abortions performed in Australia. That's one every two minutes of the working day. I think that's a national disgrace. It need not be so high if emergency contraception were available.'
Thirdly there are those who argue that the actions being taken to reduce the availability of RU 486 via the Therapeutic Goods Act are inappropriate as the drug and the manner in which it is used do not warrant this sort of parliamentary and ministerial intervention.
On the question of the appropriateness of the bill, its opponents claim the drug is not genuinely experimental and thus this sort of restriction should not be applied.
Professor Healy contends, `Three quarters of a million women have taken RU 486 at the usual dosage and no more studies at this level need be done ... It is rubbish to say it is a trial or experimental drug. That may have been true in 1986 but not any longer.'
Even if RU 486 is to be regarded as an experimental drug, opponents of Senator Harradine's bill note that its provisions do not apply to all experimental drugs being imported into Australia.
Critics of the bill argue that if it is appropriate for some experimental drugs to be imported into Australia without specific ministerial approval than this ought to be the case for RU 486.
Finally, it is argued, the bill represents an unwarranted limitation by parliament and ministers on researchers' rights to investigate the properties of certain drugs.
Dr Amanda McBride, chairperson of the Australian Medical Association's Women and Medicine Committee, has claimed, `This amendment denies the nation's women the chance for Australian research into a choice of emergency contraception that is widely used in Europe and the United States ... We are concerned that medical research is being hampered by political manoeuvring.'
Taking this point further, Dr McBride has also been reported as claiming, `This debate is not about whether abortions should or should not be allowed in Australia. This is a debate about whether legitimate scientific research should continue.'
Researchers have also expressed concern that the effect of the amended Therapeutic Goods Act will be to limit access to RU 486 for all purposes, not simply as an abortifacient and emergency contraceptive.
RU 486 is claimed to have potential for treating breast cancer and some forms of adrenal cancer. Some researchers fear that the effect of Senator Harradine's bill will be to halt experimentation with RU 486 as a cancer treatment as well as to limit its use as an abortifacient and emergency contraceptive.

Further implications
The most immediate consequence of the passing of Senator Harradine's Therapeutic Goods Amendment Bill is that the company which manufactures RU 486, Rousel-UCLAF, has indicated it will not seek to have the drug distributed in Australia.
The Australian subsidiary, Hoechst Marion Rousel Australia, has stated that it has no plans to seek approval to manufacture the drug within Australia. Its medical director, Dr Bruce Cooper, has declined to comment further.
However, it seems likely that the restrictions placed on the importation of RU 486 will not prevent morning after pills being used within Australia.
The morning after pill currently being used in Australia is a high dosage standard contraceptive pill.
It is effective up to 72 hours after unprotected intercourse. Such pills are normally only available on prescription, though the National Health and Medical Research Council recommended in November of 1995 that they be available over the counter at pharmacies, without a prescription.
A similar call for over-the-counter availability of the morning after pill has also been made by Family Planning Victoria.
This call was made some three weeks after the passage of Senator Harradine's Therapeutic Goods Amendment Bill, limiting access to RU 486.
Family Planning Victoria is also planning to conduct an education campaign in all Victorian state secondary schools, aimed at increasing student awareness of the currently available morning after pill.
A spokesperson for the Directorate of School Education has said that while the Directorate does not endorse the views of Family Planning Victoria it did support students receiving a range of balance information.
`We would expect students to form their own opinions after carefully considering the issue,' he said.
(Ignorance of currently available morning after pills appears to be quite wide-spread. A National Health and Medical Research Council survey conducted in 1994 found that 25 to 30 per cent of women had no knowledge of this form of contraception.
Another survey of 200 city and rural doctors found that only 55 per cent knew how to make up an effective emergency post coital contraceptive.)
Family planners are further concerned that there may currently be a swing of opinion against family planning and abortion within state and federal parliaments.
It has been claimed by some that the decision to limit access to RU 486 is indicative of a general position on the part of the current federal government.
Whatever the accuracy of this suggestion, it does appear to be the case that as part of the federal government's cost cutting initiatives and attempts to give greater responsibilities to the states, responsibility for family planning clinics may be given over to the states.
Family planners are concerned that if responsibility is given to the states this could result in the closure of family planning clinics.
Family planners have stated that the extent of the services clinics offer is not generally understood, so that state governments may believe that their activities could be equally well performed by public hospitals.
The executive director of Family Planning Australia, Ms Di Manning, has stressed that this is not the case. Ms Manning has stated, `It [Family Planning] is a public health program. Its main activities are education and training services for doctors and nurses, raising community awareness of sexual and reproductive issues and providing empirical research on reproductive health.'
Ms Manning has claimed that these services would not and could not be supplied by public hospitals were Family Planning clinics to be closed.
Finally, concern has been expressed that abortion may no longer be covered under Medicare.
The federal Health Minister, Dr Michael Wooldridge, has on several occasions given assurances that his government has no plans to deny Medicare payments for abortion.
However, Dr Wooldridge has said that he could not rule out the possibility that a private members bill might be put to cease Medicare payments for abortion and were such a bill to come before Parliament it would go to a conscience vote.
Dr Wooldridge has said that he would personally support such a bill, however, he does not believe that it would gain majority support.
A number of feminists have expressed concern that both the Government and the Labor Party might attempt to secure Senator Harradine's support as an independent in the Senate by supporting his conservative views on abortion and family planning.

Sources

The Age
17/5/96 page 3 news item by Sally Heath, `Australia to outlaw abortion pill'
18/5/96 page 28 editorial, `A question of choice'
22/5/96 page 5 news item by Gareth Boreham and Greg Roberts, `Bill restricts abortion drug'
22/5/96 page 18 analysis by Sally Heath, `Canberra set to ban abortion pill'
22/5/96 page 18 news item by Steve Dow, `One woman's choice'
24/5/96 page 15 comment by Pamela Bone, `Notwithstanding'
28/5/96 page 2 news item by Karen Middleton, `Call for free vote on abortion pill'
31/5/96 page 18 comment by Leslie Cannold, `Abortion pill hope'
9/6/96 page 1 (Life! section) analysis by Anita Catalano, Contraception, your choice'

The Australian
5/6/96 page 3 news item by Laura Tingle, `Family planners fear clinics may be axed'
6/6/96 page 5 news item by Laura Tingle, `Family planning a state role: minister'
7/6/96 page 13 comment by Laura Tingle, `Senators deal women out'
9/6/96 page 23 comment by Beatrice Faust, `Moves to limit choice'

The Herald Sun
12/11/95 page 7 news item by David Wilson, `"Morning-after" pill fury'
26/2/96 page 19 comment by Evelyn Tsitas, `Putting a price on woman's health'
21/6/96 page 3 news item by Cheryl Critchley, `Morning-after pill push in schools'
22/6/96 page 7 news item by Cheryl Critchley, `Concern mounts on pill'
25/6/96 page 19 comment by Andrew Bolt, `Down with baby love'

What they said ...
`Young women in Australia have the same choices their mothers had; that's not true in the rest of the First World where women have a better choice of preventing an unwanted pregnancy. Our politicians seem unwilling or unable to understand that fact'
Professor David Healy, chairman, obstetrics and gynaecology department, Monash University

`My simple point is these matters are too important to be left in the hands of science technologists ... It is the politicians who ultimately have got to wear the responsibility for the serious ill effects of such trials'
independent Senator Brian Harradine, supporting his private members bill to have the importation of RU 486 directly under the control of the Health Minister