2006/07: Should the abortion pill RU-486 be made available to Australian women?
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What they said ...
'The mind boggles that such an unsafe, lengthy, and totally unpredictable procedure - bleeding, pain, vomiting, diarrhoea, uncertainty as to whether the embryo-foetus has been fully removed - can be seen as easy, natural and left in women's hands'
Dr Renata Klein, Deakin University
'It's really a case of increasing choice ...this is another choice that should be given to women ...'
Dr Mukesh Haikerwal, President of the Australian Medical Association
The issue at a glance
On October 25 2005 the Australian Democrats launched an online petition calling on the Howard Government to overturn what they termed 'the current ban on Mifepristone', also known as RU-486.
RU-486 is a drug, first developed in France, which when used in conjunction with the hormone prostaglandin can induce a miscarriage. It is used to bring about what are termed 'medical' abortions.
The Democrats also indicated that they would seek to amend the next Therapeutic Goods Administration bill and challenge the power presently held by the federal health minister to deny approval to those seeking to import RU-486.
The Prime Minister, Mr John Howard, agreed to allow all members of the Coalition a conscience vote on the amendment, together with a related private members bill to be put up by an as yet unnamed government Senator, at the start of next year. Mr Howard has claimed that if the private member's bill put by the government Senator is passed there will be no need for the Democrats' amendment.
In the meantime, pressure to free up access to RU-486 has been increased. Caroline de Costa, a professor of obstetrics and gynaecology at Queensland's James Cook University, formally lodged her application to prescribe RU-486 with the Therapeutic Goods Administration (TGA) in November, 2005. A TGA spokesperson said the process of assessing the application could take several weeks, while the final decision rested with Health Minister, Tony Abbott.
On January 8 it was announced that three Victorian doctors had also applied to the TGA for permission to prescribe RU-486. It is believed the number of such applications is likely to increase.
Background
(Much of the following information is drawn from a research note on RU-486 prepared for the Australian Parliament. The full research note can be found at http://www.aph.gov.au/library/pubs/rn/2005-06/06rn19.htm)
What is RU486?
RU486 is the common name for the drug mifepristone, a synthetic steroid that can be used to induce what is known as medical abortion-an alternative method to surgical termination of pregnancy. RU486 has been approved for use in the United Kingdom, the United States, much of Western Europe, Russia, China, Israel, New Zealand, Turkey and Tunisia.
RU486 works by blocking the effects of the hormone progesterone, which is crucial to starting and maintaining pregnancy. Without progesterone, the lining that covers the walls of the uterus breaks down. In the absence of progesterone, the uterus cannot hold onto the fertilised egg, making it impossible for pregnancy to continue.
Generally, in a medical abortion using RU486, the woman is given a specified dose of the drug by a qualified medical professional in a licensed facility. In most cases, the woman returns home and, two days later, returns to the clinic to be administered a prostaglandin (usually misoprostol). This causes the uterus to contract, thereby expelling the products of conception, usually within a few hours. According to the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the experience for the woman 'may be much like a spontaneous miscarriage, with some pain and bleeding to be expected'.
RU486 is mainly used during the first nine weeks of pregnancy, though is also effective for second trimester termination, again in conjunction with a prostaglandin.
The legal status of RU-486 in Australia
While it is commonly believed that RU486 is 'banned' in Australia, this is not strictly the case. RU486 belongs to a special category of drugs classified under the Therapeutic Goods Act 1989 as 'restricted goods', which cannot be evaluated, registered, listed or imported without the written approval of the Minister for Health.
Restricted goods are defined under the Act as medicines 'intended for use in women as abortifacients' [An abortifacient is any chemical or other agent which can induce an abortion.] Medicines used for any purpose other than abortion are evaluated and regulated by the Therapeutic Goods Administration (TGA) without any requirement for approval from the Minister.
Despite the fact that it is possible under current arrangements to apply for approval to market RU486, no such application has been lodged in Australia. [Over the last couple of months applications have been made to prescribe rather than market the drug.]
Potential marketers appear to have concluded that making an application is not worthwhile. There are significant costs involved in putting together supporting evidence for an application to the TGA and as the Therapeutic Goods Act currently stands, once an application to market RU-486 is approved by the TGA it can still be blocked by the federal health minister.
Internet information
On December 7 2005 The Bulletin published a report by Julie-Anne Davies titled 'The Bitter Pill'. This provides a detailed discussion of some of the different interest groups involved in this issue and of its political ramifications. The article can be found at http://bulletin.ninemsn.com.au/bulletin/site/articleIDs/A4B745E0D6560003CA2570CB00087244
On November 29 2005 the Australian Parliamentary Library released a background paper titled, 'RU-486 for Australia' produced by Luke Buckmaster of the Social Policy Section. The paper supplies background information on the development of the drug, how it operates, safety issues associated with it and its current legislative status in Australia. It can be found at http://www.aph.gov.au/library/pubs/rn/2005-06/06rn19.htm
Helen Kerr of the University Health Service, University of Queensland, has produced a background paper on RU-486 titled 'Abortion Pill - Medical & Ethical Issues'. The paper looks at the original development of the drug and its current medical use in both developed and developing countries. It can be found at http://www.aic.gov.au/conferences/medicine/kerr.pdf
In October 2005 the Medical Journal of Australia published an article titled 'Medical abortion for Australian women: it's time' by Professor Caroline M De Costa, Department of Obstetrics and Gynaecology, James Cook University School of Medicine Queensland.
The article argues in favour of RU-486 being made more readily available in Australia. A full copy of the article can be found at http://www.mja.com.au/public/issues/183_07_031005/dec10429fm.html
The United States National Right to Life Committee has produced a substantial fact sheet titled 'Extensive Background Information on RU-486'. The information has been gathered by a group opposed to abortion and therefore focuses on the problems associated with the use of the drug. Though students need to be aware of the bias of the material, it is very detailed and carefully referenced and raises a number of significant concerns.
http://www.nrlc.org/RU486/ru486info.html#Didn't%20an%20Iowa%20woman
Spinifex Press specialises in publishing information of interest to women. On their Internet site they have a partial reproduction of a publication titled 'RU-486, Misconceptions, Myths and Morals' by Renate Klein, Janice G Raymond and Lynette J Dumble.
The publication examinees the drug from an essentially feminist perspective and points out problems associated with the use of the drug which it claims are not commonly acknowledged.
It can be found at http://www.spinifexpress.com.au/non-fict/ru486.htm
Religious Tolerance Org is an Internet site presenting opposing positions on a wide range of ethical issues. The site has a subsection in which it outlines the conflicting positions of the 'pro-life' and 'pro-choice' groups on the use of RU-486. This can be found at http://www.religioustolerance.org/aboru486f.htm
Arguments in favour of making the abortion pill RU-486 available to Australian women
1. RU-486 is available in many other countries
Mifepristone has now been used in about 2 million terminations in more than 30 countries, including European nations, the United States, Britain, New Zealand and China.
According to the Australian Reproductive Health Alliance, Australia is the only Western country, with the exception of Catholic nations such as Italy and Ireland, where the drug is unavailable.
2. There are no longer significant concerns about the safety of RU-486
Caroline de Costa, professor of obstetrics and gynaecology at James Cook University. Has claimed, 'I think it's reasonable to say there were reservations (about mifepristone) then [when the drug was first banned in Australia] but since then medical evidence in favour of mifepristone, also known as RU486, has continued to grow.'
Andrew Pesce of the Australian Medical Association has also stated, 'If there were any concerns about its safety or effectiveness they've been to a large degree dispelled with over 10 years experience in other countries with more than 2 million registered users indicating that it's safe and effective as an option for women who decide for whatever reason they need to seek a lawful abortion.'
The drug was first approved for clinical use in France in 1988 and has been used there successfully ever since as well as in a growing number of other countries.
The director of women's services at the Royal Women's Hospital, Dr Chris Bayly, has claimed that research has shown that mifepristone, taken in conjunction with synthetic prostaglandins, can be used safely to induce medical abortion.
In 2000 the United States Food and Drug Administration approved mifepristone.
3. Many medical authorities support the increased availability of RU-486
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Rural Doctors Association, the Australian Medical Association, The Medical Journal of Australia, the Royal Women's Hospital, Family Planning Victoria, the World Health Organisation and the Public Health Association of Australia all argue that Australian women should be given access to RU-486, a drug also known as Mifepristine.
Andrew Pesce of the Australian Medical Association has stated, 'It doesn't make sense to have an overall ban of something which would be suitable for the majority of women.'
4. Many women would find medical abortion less traumatic than surgical abortion
When the abortion pill was trialled in Australia in 1994 it was noted, 'Many of the women . . . commented on the friendly, non-clinical approach, which they considered psychologically beneficial at a time when anxiety levels were increased.'
Fifteen of the women in the 1994 trial had previously had a surgical abortion - all said they preferred mifepristone. 'I was much more able to cope with my decision to have a medical termination as I was conscious the whole time and did not feel that my body was invaded,' one woman said.
Professor David Healy, Monash University chairman of obstetrics and gynaecology,has argued that by enabling abortions to be carried out within days, instead of having to wait at least four weeks for a surgical termination, mifepristone can reduce the trauma of abortion - even to the point of being used as a morning-after pill.
'If we could prevent that psychological stress, that would be a good thing,' Professor Healy has claimed.
5. RU-486 can be a safer option than surgical abortion
Surgical abortion comes with risks such as damaging the uterus and cervix, blood clots and infections. Side effects from mifepristone include nausea, vomiting, diarrhoea, heavy bleeding and abdominal cramps. Both result in bleeding for several days.
There are those who have argued that mifepristone has fewer significant side-effects than surgical abortion and so, in many circumstances, represents a safer option for women seeking to end a pregnancy.
6. As abortion is available throughout Australia, it is illogical to ban an abortifacient
Each year as many as 100,000 surgical abortions are carried out in Australia. Supporters of making RU-486 available to Australian women argue that given the prevalence of abortion in this country and the range of abortion and contraceptive procedures available to women it makes no sense to ban a drug such as mifepristone.
Caroline de Costa, professor of obstetrics and gynaecology at James Cook University has argued, 'It's anomalous. We have emergency contraception, we have surgical abortion, we have a whole lot of other things that we consider reasonable for women's health, but we don't have this option ...'
It has also been argued that limiting some forms of abortion will have no effect on the prevalence of the procedure. In an article published in The Herald Sun on October 16, 2005, Robyn Riley argued, 'Experts warn that restricting access or creating barriers to abortion services will not stop them happening ... What it will do is force some women to seek less safe ... services.'
7. Surgical abortions are often not available in country areas
It has been claimed that for a variety of reasons, including the social and moral conservatism of some areas, it is often difficult for women living in the country to have an abortion performed near where they live. Many are required to travel to state capital cities to have the procedure performed.
The Age newspaper contacted many Victorian country hospitals to discover the availability of abortions in the areas served by these hospitals. The director of nursing at the Wangaratta Hospital, Chris Giles, indicated that the hospital rarely does abortions, having performed only two in the last seven years, both involving severe foetal abnormalities. Most women apparently go to Albury or make a three-hour trip to Melbourne. Giles stated, 'Neither of the obstetricians here are keen to do them.'
A spokesperson for the Latrobe Regional Hospital, Jenny Ginnane, stated, 'We don't have any doctors who do elective abortions. It's up to the visiting medical officers whether they choose to do an operation and currently we don't have anyone who chooses to do them.' Apparently, abortions 'in extreme circumstances' do occur but very rarely.
Bronwyn Wheatley, a spokesperson for Bendigo Health, stated, 'We don't do them [abortions] at all. It's not our policy to do them.'
It has been argued that under these circumstances RU-486 makes abortion available to many country women who would otherwise have to travel to a capital city in order to have the procedure surgically performed.
8. The decision to ban RU-486 was politically motivated
It has been repeatedly claimed that the Howard Government has exploited women's health issues, especially those focusing on reproductive rights and abortion as a means of gaining political advantage. In 1996, when Michael Wooldridge was the health minister, the effective ban on RU486 was initiated by Catholic independent MP Brian Harradine, who has a strong abjection to abortion. The Government gave way to Senator Harradine's demands at least in part because it needed his support when it did not have a majority in the Senate. Critics maintain that the availability of RU-486 was never given a fair political hearing in the Australian Parliament because the Government was too busy attempting to win over Senator Harradine at the time the terms under which the drug should be made available to Australian women was being debated.
As a further instance of supposedly prejudiced treatement of the issue, when Dr Wooldridge nominated Professor John Funder to be chairman of the National Health and Medical Research Council in 1997, Senator Harradine objected. Funder had written a discussion paper that argued in favour of the availability of RU486 on the grounds of its safety, and Harradine lobbied hard against him, apparently on this basis. The Government appointed someone else despite 24 of Australia's top medical experts endorsing Funder.
9. The current limits on the availability of RU-486 restricts access to it for other medical purposes
Professor Ian Fraser from the Department of Obstetrics and Gynaecology, Sydney University has stated, 'We think it is important for Australians to know that there are other legitimate uses of mifepristone and it is crazy that we can't get access to the drug without the special permission of the health minister.
Those uses include treatment for some cancers and endometriosis and ... in a trial being conducted by Australian scientists on behalf of the US National Institute of Health, using RU 486 to treat bleeding in women with a contraceptive implant. The existing situation means that an application for either marketing the drug or for use in clinical trials can be rejected on a political basis.'
Studies have found the drug useful in the treatment of a range of disorders including endometriosis, breast cancer, ovarian cancer, Cushing's syndrome and some psychiatric disorders. Only a handful of Australians have been given approval to import the drug to help treat brain tumours known as meningiomas. Critics have argued that the restrictions on the importation of the drug have hindered research into its other applications.
Arguments against making the abortion pill RU-486 available to Australian women
1. RU-486 poses significant health risks for the women who use it
There have been nine known deaths from mifepristone and a large number of near-fatalities.
Despite careful screening to eliminate unsuitable candidates, two percent of those participating in United States trials of RU486 haemorrhaged. One out of a 100 had to be hospitalized. Several women required surgery to stop the bleeding and some bled so much that they had to have transfusions.
It has been suggested that in the broader, less regulated medical marketplace, outside the careful monitoring of a clinical trial, complications could be expected to be both more common and more serious, especially for those women who do not have immediate access to emergency care.
Nausea, diarrhoea, vomiting, and cramping are also common side effects, and sometimes in clinical trials were themselves severe enough to put women in hospital. Less frequent, but potentially more serious, are side effects such as infection or heart palpitations.
2. RU-486 has a significant failure rate
According to preliminary advice provided to the federal Department of Health and Ageing, up to 10 per cent of women who use RU-486 end up back in hospital having a dilation and curettage procedure.
Writing in an opinion piece published in The Australian on November 17, 2005, Christopher Pearson remarked, 'Mifepristone is far from being a panacea. If one in 10 of the women who use it have an unpleasant and unsatisfactory experience - and then have to face the kind of surgical intervention they'd hoped to avoid in the first place - I can't see it becoming a popular option.'
The RU486/PG method drops off significantly in effectiveness after the seventh week of pregnancy and is not an effective agent against ectopic pregnancies. In the case of a misdiagnosed tubal pregnancy the result could be a ruptured fallopian tube and long-term damage to the woman's health and reproductive capabilities.
3. RU-486 is more expensive than a surgical abortion
Writing in an opinion piece published in The Australian on November 17, 2005, Christopher Pearson remarked, 'Given that the drugs are more expensive than surgery and an adequate supervision process more time-consuming, [RU-486 does not] seem a rational way of allocating scarce health resources.'
This judgement appears to be based primarily on the United States' experience where the price of an RU486/PG abortion, with Danco (the manufacturer) charging $270(US) for a single dose of the RU486 pills, is an issue for abortion clinics. The chemical option becomes even more expensive once the additional cost of three office visits, lab work, and counselling together with the cost of one or two ultrasounds, effectively requiring the clinic staying within the United States Food and Drug Administration approved protocol to offer the RU486/PG method at a loss or to charge a rate substantially higher than that of a corresponding surgical procedure.
Cost has also been an issue in New Zealand where Sandra Coney, the executive director of the Women's Health Action lobby group has noted, 'RU 486 costs the same as or is more expensive than surgical abortion when used as recommended.'
4. There is a risk that RU-486 will be used without medical supervision
The conditions under which RU-486 should be administered require careful medical supervision. Also, currently available prostaglandins must be kept refrigerated. These conditions have particular ramifications if RU 486/PC is to be distributed in areas of western countries, including Australia, where disadvantaged and other minority women do not have access to appropriate medical services. For these and other reasons, the 6th International Women and Health Meeting, held in the Philippines in November 1990, issued are resolution opposing the trials and the introduction of RU 486/PG especially in third world countries.
Dr Margaret Sparrow of the New Zealand Women's Health Action Trust has flagged a number of issues regarding the drug's use if not properly supervised. Dr Sparrow has noted that there are a number of issues arising from the fact that many women will abort at home. Women's safety may be compromised if disapproving family members learn of a secret pregnancy/abortion. There is a risk of a failure to complete the regime if women do not understand the implications of not doing so. Women may also fail to seek medical assistance if complications occur.
5. RU-486 is not suitable for use by women living in rural areas
It has been claimed that because RU-486 can have significant complications (including haemorrhaging, partial delivery and septicaemia) it is unsuitable in any situation where the woman who has taken the drug does not have reliable access to medical supervision and emergency medical assistance.
This point has been made by Senator Ron Boswell, the leader of the Nationals in the Senate. The senator has claimed there is a growing body of evidence suggesting the drug RU486 could prove fatal for some women, especially those in rural areas.
Senator Boswell has said that the manufacturer's warnings should set alarm bells ringing for women in rural and remote areas without ready access to hospitals.
The Senator has stated, 'Women in rural and remote Australia without access to emergency surgical care may be at risk if they take the drug. I mean rural women can't be stuck next to the hospital the whole time. That's why Danco (the drug's United States' manufacturer) advises women not to take it unless emergency medical help is available for the fortnight after the drug is taken. That would preclude many women in rural Australia from safely taking the drug where they cannot access emergency care close by.'
Senator Alan Eggleston, a former GP obstetrician, backed Senator Boswell's concerns. Senator Eggleston has stated, 'The potential for problems resulting from the use of RU486 in country areas where quick access to a surgically equipped hospital was not always possible should raise serious concerns about the wisdom of making this medication generally available.'
6. Using RU-486 can be psychologically and emotionally difficult
It has been noted that because the drugs administered to induce the abortion do not work immediately, the women seeking an abortion has to wait anywhere between two days and a week before her foetus is expelled. It has been argued that this can be very distressing for some women.
Edouard Sakiz, the former chairman of Roussel-Uclaf, the French company that developed RU-486, has claimed, 'As abortifacient procedures go, RU-486 is not at all easy to use ... True, no anaesthetic is required. But a woman who wants to end her pregnancy has to live with her abortion for at least a week using this technique. It's an appalling psychological ordeal.'
It has also been claimed that while those who undergo surgical abortion only imagine what their unborn children look like and go through, women who have abortions with RU486 have vivid memories of their induced miscarriages. Women who have undergone RU486/PG abortions talk about seeing tiny fists, eyes, or seeing their aborted babies laying in the toilet bowl or swirling in the shower drain. It has further been suggested that the relative isolation of the experience may well increase a woman's sense of responsibility for the abortion.
7. Depending on where RU-486 is manufactured it may not be possible to regulate its manufacture properly
The Population Council and Danco Laboratories, the United States company formed to distribute mifepristone, were unable to identify an American-based pharmaceutical company willing to manufacture the drug. So, they turned overseas to Communist China, where Danco signed a contract with the state-owned Shanghai Hua Lian Pharmaceutical Co., Ltd.
United States Congressional investigators say the Chinese company and its Shanghai plant have been cited by federal regulators for bringing mislabelled and impure drugs into the United States.
There is concern in the United States and elsewhere that RU-486 may be manufactured in countries such as China, where it is difficult to properly regulate its production and then be imported into other nations.
8. Some of the supposed advantages of RU-486 have been misrepresented
It has been suggested that RU-486 has been promoted to women in a way that is misleading. For example, it has been claimed that RU-486 will allow a woman greater privacy and allow her greater control over her abortion. This claim has been made by American syndicated columnist, Ellen Goodman, who has posed the apparently rhetorical question, 'What could he more private than taking a pill?'
Critics of RU-486 say that the reality of taking the pill is otherwise, as, unless there is careful medical supervision the drug cannot be taken with an appropriate level of safety.
It has been claimed in 'RU-486, Misconceptions, Myths and Morals' by Renate Klein, Janice G Raymond and Lynette J Dumble that 'The reality of medical surveillance is not simply physician oversight from a distance, but a highly medicalized, multi-step, time-consuming procedure which, for many women, involves continuous suffering and pain.'
9. Chemical abortions can result in foetal abnormalities
Dr. Bernard Nathanson, co-founder of the (United States) National Abortion Rights Action League has stated, 'RU-486 is a drug which acts on the female reproductive system, and with anything that does that we have to be keenly aware of what are called transgenerational effects. One such drug acting on the female reproductive system was given to women during the 1940s and 1950s to stop excessive bleeding and to prevent miscarriages. Although the drug proved to be ineffective, it had an unintended side effect. Many female children of the women who had taken the drug suffered from a transgenerational effect and developed vaginal cancer, which led to numerous mutilating operations and death.
Another concern regarding RU-486 is that a woman who starts taking the pill may decide to carry the baby to term. The result can be serious skull deformities for the newborn.'
Further implications
It has seemed for some time that the nature of the abortion debate in Australia has shifted. The previous discussion of the ethics of abortion centring on the conflicting moral claims of the woman seeking the abortion and of the foetus she wanted to abort seemed to have largely disappeared.
Though abortion is still a crime in most Australian jurisdictions, exceptions allowing for abortion where the mother's physical or psychological wellbeing is considered to be at risk if the pregnancy continues have effectively legalised the procedure and with this it appears that most of the overt moral heat has been removed from the issue. The latest debate is about the method rather than abortion per se.
Very few of the critics of RU-486 have openly complained that it is likely to increase the incidence of abortion. Instead it has been criticised as a potential risk to the health of the women who use it. Feminist critics who object to RU-486 tend to do so on the basis that it increases rather than reduces the medicalisation of abortion.
However, critics of the current Minister for Health, Mr Tony Abbott, complain that he is using his power to block the importation of RU-486 as part of a wider campaign designed to reduce rather than increase the availability of abortion to Australian women. If this is the case, the issue will not go away.
The four applications to the TGA by specialist medical practitioners seeking to prescribe RU-486 is likely to be only the start of a more general campaign designed to draw attention to the fact that Mr Abbott is prohibiting a drug that is available in most of the countries with which Australia generally compares itself.
This creates political problems for the government. There is a major rift within the Coalition between those who support women's access to abortion and those who do not. Given this, a conscience vote on RU-486 was the only course open to the Prime Minister. However, the issue will not disappear while the federal health minister has and exercises the power to block the importation of the drug.
It will be interesting to see what sort of private member's bill is put up by a government Senator in early 2006. It is likely to be one that puts a renewed stress on the potential health risks of RU-486 by continuing to make it difficult to import. It is also probable that it will remove from the federal Health Minister the final power to approve import applications.
Newspaper sources section
AGE, November 17, page 3, news item by David Wroe, `PM faces revolt over abortion pill'.
AGE, November 16, page 19, comment by Michelle Grattan, `Tony Abbott, the new drug watchdog'.
AGE, November 16, page 7, news item by David Wroe, `GPs blast advice on abortion pill'.
AGE, November 19, Insight section, page 3, analysis by Karen Kissane, `RU serious?'.
AGE, November 21, page 12, editorial, `Let the medical experts do their job, minister'.
AGE, November 24, page 19, comment by Sushi Das, `Mr Abbott, minister for meddling'.
AGE, November 24, page 5, news item by David Wroe, `Lift ban on abortion pill: doctors'.
AGE, November 29, page 15, comment by Lyn Allison, `Abortion drug is a safe and tested choice'.
AGE, November 30, page 9, news item by David Wroe, `Conscience vote on abortion drug delayed until 2006'.
AGE, December 5, page 15, comment by Leslie Cannold, `Delay in drug debate spells trouble for free choice'.
AUST, November 12, page 30, comment by Christopher Pearson, `Risky drug of pro-choice'.
AUST, November 14, page 6, news item by Samantha Maiden, `Abortion drug a "risk to women"'.
AUST, November 15, page 2, news item by Samantha Maiden, `Backlash for Abbott in abortion debate'.
AUST, November 16, page 3, news item by Samantha Maiden, `Abortion pill ban will stay: Abbott'.
AUST, November 19, page 20, comment by Matt Price, `Sneaky kill-the-pill ploy is an insult to us all'.
AUST, November 19, page 6, news item by Elisabeth Colman and Andrew McGarry, `Call for "respect" in abortion debate'.
AUST, November 25, page 7, news item by Samantha Maiden, `Nelson in favour of lifting ban on abortion pill'.
AUST, November 30, page 3, news item by Samantha Maiden, `PM offers Dems abortion pill deal'.
H/SUN, December 12, page 18, comment by Paul Gray, `An abortion drug tragedy'.
H/SUN, November 16, page 22, comment by Natasha Stott Despoja, `Helping women left in anguish'.
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