RU 486: A Psychological Nightmare for Women

Washington DC

- When Rachel heard that RU-486 had been approved, she dropped the laundry basket and ran downstairs to turn on the TV. As the newscaster announced the "breakthrough," Rachel was thinking: "If I hadn't taken it, right now I'd have a newborn in the house; which room would he or she sleep in?" Those broadcasts Rachel saw last month described the Food and Drug Administration's approval of the dangerous abortion drug RU 486. Its very nickname -- "the abortion pill" -- supposedly implies convenience and ease, liberation from the hassles and stigma of surgical abortions. However, as Rachel and other women who've taken the dangerous abortion pill can vouch, there's little that's easy about RU-486. American women who've used the drug describe as it as less convenient and more messy, and sometimes more painful, than surgical abortion, according to those who have conducted trials on 9,000 women so far. Yet many chose it not despite those obstacles, but because of them. The pain factor made it seem more "natural," some abortion practitioners claim. Taking the abortion drug at home gave them a greater sense of control. And some even said the control and suffering served as a way to confront their own moral dilemmas. "When I'm doing the initial counseling and a woman says she really wants [the pregnancy] over with quickly or if she has a very busy schedule, she will generally not end up using [RU-486]," said Kathy Rogers, a researcher at Johns Hopkins University in Baltimore, one of 18 sites for the latest clinical trials. "Because it's not just a pill; it's a process. And it's not going to be easy or fast or simple." In demographic terms Rachel -- who agreed to be interviewed if her name were not disclosed -- is not the prototype RU-486 user. She is six years older than the average age of 28, and is married, with two children. But judging from interviews and published studies, her reactions are quite typical. She absorbed her nurse's warning that taking RU 486 would be "more painful, with all the bleeding and cramping." Still, she chose it because "it gave me a sense of control. Because it's something that I choose to do, rather than something that's done to me." By that she means common medical concerns about invasive surgery, and the physical trauma to the body. But she also means something more personal, more emotional--a feeling the pill's advocates don't like to talk about but which nonetheless seems common to the women who take RU 486. It served for her as a form of penance, a way of grappling with her ambivalence over any kind of abortion and killing her unborn child. "It was like, if I'm going to do this I have to take the responsibility and do it myself, and I have to put myself through something hard," she said. "It would have been cowardly to have someone fix it for me in some easy, safe way. It would not have felt right. "You know, I still think about it almost every day," she continued. "I will always wonder what this baby would have been like. I still don't think I did the wrong thing, but I wish the whole thing had never come up." As post-abortion experts point out, the stigma and pain of the of abortion is kept alive whether the abortion is surgical or chemical in nature. However, abortion advocates refuse to call it guilt. "That's a red flag for us, if a woman is overwhelmed by guilt," Rogers said. "The logic is, even if takes longer, even if it hurts more, there's a sense of doing it yourself, rather than being done unto," said Carolyn Westhof, who conducted the trials at the Columbia Medical School in New York. "Often it's not really a medical decision, but a psychological one." Yet much about Rachel's experience suggests that RU-486 may not change the abortion climate in America quite as much as expected. Not at the political level, between abortion advocates and pro-life advocates, and especially not at the personal level, where a woman confronts her neighbors, her family and her conscience by virtue of what she's done. When Rachel found out she was pregnant just before New Year's Day 2000 she decided to have an abortion. "When I discovered it I thought, 'Oh my God I can't do this,' " she recalled. "My second child turned out much more demanding; I scream at her almost every day. And I thought, what's the next step? I'll start hitting somebody. I was really concerned I might become an abusive mother." She stayed up until 3 a.m. talking it over with her husband, and by the end of the second day they'd made up their minds. The next morning she immediately called her obstetrician, who had seen her through two pregnancies. This is the stage were pro-life advocates can hold out hope; namely, that doctors will refuse to hand out RU 486 because they are unwilling to perform surgical abortions when RU 486 fails to kill the unborn child because it is taken too late into the pregnancy. Here Rachel encountered frustration because her doctor refused to hand out RU 486 or perform an abortion. Rachel looked up Planned Parenthood in the phone book. She called, and the counselor on the phone pointedly affirmed her decision to have an abortion. Once she determined that Rachel was in the first weeks of pregnancy, she directed Rachel to a local facility conducting RU 486 trials. She made an appointment for the first day she could, the Tuesday after New Year's. There she listened to an explanation of the differences between a surgical and chemical abortion -- an apparently was given no encouragement to choose abortion alternatives. She first sifted through her emotional state. "Finding out I was pregnant and not wanting it made me feel I was losing control of my life. All New Year's I kept thinking of the same sentence: 'Stop the train, I want to get off.' " RU-486 seemed the way to "regain that control," she said. "I thought about the differences; about going into a room in a paper gown and having someone do something to me with instruments. Ugh. As opposed to keeping my clothes on and taking the pill myself. Me doing it, to myself." >From the counselor's descriptions, Rachel concluded RU-486 "was just like having a miscarriage. It might be painful, I might bleed," she thought, "but it will be more natural; my body will be doing it to itself." And then her final thought before she gave her answer: "I thought the least I could do was suffer a little." She took the first of two drugs at Planned parenthood that day and "felt a huge weight lifted off my shoulders. I could literally feel it. It was the first time I understood what that phrase meant." But no moment since has been quite so weightless. What happened to Rachel afterwards was nothing short of a horrific nightmare. She still hasn't told anyone except her husband about what she did. Not her best friends, not her two children, certainly not her mother who, like Rachel herself, "would spend the rest of her life wondering what this child would have been like." Her heart still jumps every time she passes the house next door, the house of a man "who is very religious and I don't want to think about what he would do if he knew I'd had what I'm sure he considers just plain old abortion." She considered going public until she scanned the Internet the day the news broke and read the reactions of abortion opponents: "They talk like we make this decision so cavalierly. Yeah, right. Like they need to make us feel guilt. Like there isn't plenty of that already." And she still remembers most vividly the last moment of the whole ordeal; when she woke up for the millionth time and went to the bathroom the morning after taking the second part of the dangerous abortion drug, feeling crampy and achy. She looked down and saw the unborn baby. She looked at the baby for a long time because the baby was bigger than she expected. She stared for what seemed like an hour--frozen, tired. "It seemed rude to flush it," she thought to herself. "I should be having a burial or something." But then she heard her daughter awaken and thought: "Well, you have to get on with your day."