UHS Approves Abortion Pill

Harvard students can now receive the abortion drug RU-486 through a referral from University Health Services (UHS). But UHS Director Dr. David S. Rosenthal '59 said yesterday that UHS has no plans now or in the future to dispense RU-486 in Holyoke Center.

As of Jan. 1, students could obtain the treatment at Planned Parenthood in Brighton and UHS can also send students to Brigham and Women's Hospital in Boston for the procedure.

RU-486, also know as mifepristone, is taken within the first seven weeks of pregnancy in conjunction with misopristol tablets in order to induce a miscarriage.

In approximately 5 percent of cases, a follow-up surgical procedure is necessary to complete the abortion.

The RU-486 treatment costs around $450 dollars while surgical abortions are usually $350. Deborah Cohen, coordinator of pregnancy and peer counseling at UHS, said students seeking a medical abortion via RU-486 will receive $275 dollars from UHS towards the procedure, the same amount that is currently given for surgical abortions.

Since the level of UHS funding for abortions remains the same, despite the new RU-486 option, students electing to get a refund on the portion of their Student Health Services fee that helps fund abortions will still only receive a $1 reimbursement.

Shauna L. Shames '01, who has been involved with Harvard Students for Choice and the Coalition Against Sexual Violence, said she thought RU-486 should be given directly through UHS and students should only have to visit another facility if they require a follow-up surgical procedure.

"It doesn't make sense to have to go all the way into Boston just to get a pill," she said. "It would make sense for UHS to offer [RU-486] just like the 'morning after' pill."

Students can currently obtain oral contraceptives, including the "morning after pill," and term bill them through the UHS pharmacy.

Melissa R. Moschella '02, president of Harvard Right to Life says the group opposes RU-486 both because it is a method of abortion and because they think it is a treatment that would be difficult for students to deal with.

"After taking the drug a student will naturally miscarry at any time and a college dorm or campus is not a suitable place for this to happen," she said. "It has the potential to be more disruptive if widely used than to just the person involved."

Even though UHS will not be offering RU-486 on site, by virtue of the Food and Drug Administration's (FDA) approval, both Rosenthal and Cohen said that Harvard students have the right to the new procedure, stressing that it is a private procedure.

"It isn't something people would go around sharing with lots of people, only confidantes and close friends," Rosenthal said.

The (FDA) requires doctors who prescribe RU-486 to have access to surgical services if complications occur but does not require those surgeons to be available at the place RU-486 is administered.

But Rosenthal said that whoever dispenses RU-486 needs to be able to follow the patient through three visits and should be the one to perform the surgical abortion if it becomes necessary.

"We can't [dispense RU-486] because we have none of the available services to do abortions here nor would we ever want to," he said.

When a student comes to UHS seeking an abortion, UHS offers her a medical examination to assess the status of her pregnancy. She then has the option of receiving counseling to help her deal with her decision.

"Students are strongly encouraged to meet with pregnancy counselors in mental health," said Cohen. "We talk with them about what options are available and then refer them."

If a student chooses a surgical abortion, the procedure can be performed at Women's Health in Chestnut Hill, Brigham and Women's Hospital, or Planned Parenthood.

Cohen said that if a student asks for the RU-486 treatment, the counselor will refer her to either Planned Parenthood or Brigham and Women's Hospital, UHS's two referral services that currently offer the drug.

A representative from Planned Parenthood said that when a woman elects to have an abortion via RU-486, she has an initial appointment including a lab test, an ultrasound and a pelvic exam.

Next, she takes the RU-486 pill orally under the supervision of medical personnel. Forty-eight hours later, she inserts small tablets of misopristol into her vagina.

Heavy bleeding and cramping ensue, and 80% of patients pass the pregnancy itself within four hours. Ninety-two percent experience a complete miscarriage within 24 hours.

However, the Planned Parenthood representative said that it could take the woman up to a week to pass the fetus. The patient might be one of the approximately five percent of women who require a follow-up surgical procedure to complete the abortion.

The patient is required to call the clinic responsible for her treatment forty-eight hours after inserting the vaginal tablets and check-in with a nurse a day later.

In a week to a week and a half, the Planned Parenthood representative said, the patient receives another ultrasound and pelvic exam to see if the abortion was completed.

The Brighton clinic is the only one of its type in the area to currently offer medical abortions using RU-486, the representative said yesterday.

"RU-486 is more popular just because more people know about it, but medical abortions [using other drugs] aren't a new thing," she said.

Before the approval of RU-486, she said, Planned Parenthood received around four appointments a week for medical abortions using methotrexate and misopristol.

Although these drugs were not approved by the FDA explicitly for medical abortions, in 1995 the New England Journal of Medicine published a study stating that the treatment was 96% effective if taken in the first 63 days of pregnancy.

With this pre-RU-486 method, methotrexate was administered through an injection in the thigh and the patient deposited misopristol tablets into the vagina 48 hours later, inducing a miscarriage.

Cohen said that no students were ever referred from UHS for this type of medical abortion.

The Planned Parenthood representative said the RU-486 treatment works more quickly and is more effective than methotrexate.

However, she said the clinic still receives only 9 to 12 appointments for RU-486 treatments each week as opposed to 150 for surgical abortions.

"The medical abortion takes time and flexibility," she said. "Surgical abortions are also cheaper."

Cohen said that mental health services will continue to be available for students who have undergone the RU-486 treatment, just as they have been for students who opt for surgical abortions.

"All the follow-up medical care [for RU-486] will be done through Planned Parenthood or Brigham and Women's," she said. "But UHS will be available to do all the counseling."

Staff Writer Heather B. Long can be reached at hblong@fas.harvard.edu