Drugs used for birth control can either prevent pregnancy or terminate pregnancy. These two groups of drugs act in different ways, and the ethical considerations and emotional responses regarding their use have generated varying degrees of controversy. Hormonal contraceptives prevent pregnancy by interfering with the release of the ovum or impairing the ability of the fertilized ovum to attach to the wall of the uterus. Although lower doses of mifepristone can prevent ovulation and be used as an emergency contraceptive (morning-after pill), it is primarily employed as an abortifacient to terminate an established pregnancy. It is the medical alternative to a surgical abortion.
Mifepristone was originally synthesized in 1981 by the French pharmaceutical company Roussel-Uclaf and assigned the designation RU-486. Marketed worldwide as Mifeprex and Mifegyne, it blocks the female hormone progesterone, which the body needs to maintain pregnancy. In 1988, it was approved in France for medical abortions. Many European countries approved its use during the 1990s, and the United States followed in 2000. To avoid antiabortion protests and boycotts in Europe and the United States, the rights to this drug have been commonly transferred to single-product (mifepristone) companies. In the United States, it can only be obtained directly from selected physicians.
In most countries, mifepristone is approved to terminate pregnancies of up to forty-nine days. It is taken in a dosing regimen with the prostaglandin-like drug misoprostol, which causes contractions of the uterus. Within twenty-four to seventy-two hours after drug treatment, uterine contractions occur, resulting in a miscarriage. Mifepristone is about 95 percent effective within two weeks.
Challenges to its approval and use have focused on its safety, adverse effects, and the ethical and religious issues associated with terminating pregnancies by abortions, whether surgical or medical. Almost all women experience abdominal pain, cramping, and vaginal bleeding—sometimes severe—for nine to sixteen days. Unlike surgical abortions, medical abortions can be undertaken in the privacy of the woman’s home.
SEE ALSO Estrone and Estrogen (1929), Progesterone and Progestin (1933), Enovid (1960), Plan B (1999).
All pregnancy tests work by detecting human chorionic gonadotropin (hCG), a hormone that is only present if a woman is pregnant. Although home pregnancy tests can be very accurate, a positive test (shown here) may occur when the woman is not pregnant.