Last year doctors performed around 23,000 surgical abortions in the Czech Republic, a fifth of them for health reasons. Now women who decide to end their pregnancy in its early stages have the option of using the newly available abortion pill RU 486. While many women welcome the chance to replace surgical abortion with a less invasive method of inducing miscarriage, critics and pro-life activists are vehemently protesting the pill’s registration.
The RU 486 abortion pill arrived in Czech pharmacies in mid-June and doctors have already administered it to several dozen patients. In the course of the first fortnight alone Czech hospitals ordered 370 items. Interest in the abortion pill is considerable as is the controversy surrounding its registration.
First introduced in France in 1988, the pill is now legally available in 25 countries and has been used by millions of women. The possibility of registering it was first discussed in this country in the 1990s and then again in 2005 without any tangible result. Almost a decade later the pill has become legally available to Czech women, some of whom risked their health in the past by ordering it over the internet and applying it without medical supervision.
The RU 486 pill is a synthetic steroid that blocks the production of the hormone progesterone which is essential for pregnancy to continue. It is used to end pregnancies that are less than 49 days old and is administered as a combination of two pills taken under medical supervision. The first –mifepristone- blocks pregnancy hormones from reaching the uterus and is administered by a gynecologist in hospital. The second – misoprostol –is administered 48 hours later inducing miscarriage. A fortnight after that the patient comes in for a final check-up. The women who undergo this procedure are briefed in detail about possible complications and are given an emergency number they can call at any time in the event of problems.
The pill does not provide a 100 percent guarantee of inducing miscarriage and the probability of it failing has been established between 1.3 and 7.5 percent of cases. It is more effective taken earlier on. Like most medicines it has possible negative side effects, but many gynecologists still consider it a safer and less traumatic means of ending unwanted pregnancies than surgical abortion. Both procedures cost between 3,000 and 4,000 crowns.
Doctor Křepelka from the Prague Institute for the care of Mother and Child in Podolí says that 10 patients have already been treated with the RU 486 pill at the Podolí clinic and there have been no complications. He explains in what way the abortion pill is safer –
“The abortion pill rules out the possible risks of surgical abortion. For one, such an abortion is performed under total anesthesia and that alone is not without risk. Secondly the surgical procedure carries the risk –albeit small - of potential damage to the lining of the womb, which can lead to bleeding and infections and can lower a woman’s chance of conceiving in the future.”
The pill is available on prescription only, it can only be obtained by hospital staff and is administered under medical supervision. Even so some gynecologists do not recommend its use. Xenie Prainingerová who has a practice in Jaroměřice nad Rokytnou says the pills registration was not a good move.
“This abortion pill will only lead to greater irresponsibility. Due to the use of contraceptives the number of abortions has been dropping so I really see no reason to bring in new abortion methods. Moreover according to the law a woman must undergo abortion in a medical facility, under medical supervision. In this case that condition is not fulfilled properly and doctors should keep in mind that they are exposing themselves to the possibility of law suits as a result. ”
The NGO Pro-Life, which organized a petition against the pill signed by 70,000 people, echoes these sentiments. It has already filed a legal complaint against the State Institute for Drug Control on the grounds that the pill’s registration is in violation of the law. Pro-Life activist Zdenka Rybová argues that the pill is a health hazard –since the miscarriage takes place outside a medical institution -and criticizes the fact that it was registered without a proper public debate. She also agrees with doctor Prainingeroivá that it will lead to greater irresponsibility on the part of some women.
“I think you would find that there is general agreement across the country that it would be good to minimize abortions as much as possible. And this pill is being presented as a simple, easy and relatively risk-free abortion which is widely accessible to everyone. Moreover there has been no proper public debate on the issue and certainly no consideration of the psychological trauma that a woman who is sent home and will miscarry on her own somewhere may suffer. That in itself is something that needs to be addressed. The medical care given to a woman considering abortion should not boil down to a pill being handed over – there should be prevention and advice on alternative solutions – a more comprehensible approach from the state.”
Doctor Křepelka from the Prague Institute for Mother and Child counters that the abortion pill is merely offered as an alternative to women who have already made up their minds to undergo abortion one way or another and he says that data from abroad do not indicate that the availability of such a pill makes women more careless or more irresponsible.
“We have at our disposal data from countries which have been using the abortion pill for many years now and in none of those countries has there been a rise in the number of abortions as a result of the pill’s registration. Moreover the Czech Republic has a very good record in this respect the number of abortions had been steadily decreasing since the early 1990s due to the fact that 50 percent of Czech women in the reproductive age bracket use contraceptives. So all I can say is that this pill is only offered to women who have firmly made up their minds to undergo abortion. They are given the choice between the abortion pill and surgical abortion, briefed in detail about the procedure and possible side effects and it is up to them to choose what suits them better. ”
At present the abortion pill is administered in 30 hospitals around the country. Under the conditions stipulated it can only be prescribed by medical institutions which have in-patients, meaning that a patient could be hospitalized should complications arise. The procedure –with the final check-up involves three hour-long “outpatient” visits and is concluded within around 16 days.