Colleges' New Abortion Question

By Thomas White | Monday, January 15, 2001

'We have never done abortions and we never will,' says Dr. Jack Turco, director of the Dartmouth College Health Service.

Turco refers specifically to RU-486, the newly FDA-approved abortion pill, known generically as mifepristone. The College, he said, does not have the necessary facilities to dispense the abortion pill. Abortion providers, even those primarily dispensing RU-486, should have sonogram equipment, to precisely date conceptions and identify failed abortions, and the means to perform surgical abortions, if necessary. Anywhere from eight to 23 percent of RU-486 abortion attempts are unsuccessful, merely damaging the fetus and requiring such emergency treatment.

So, while the College will not prescribe RU-486 directly and does not itself perform abortions, it will refer any abortion-seeking student to the Dartmouth-Hitchcock Medical Center, drive her the less-than-five-miles there, and, if she is covered by the Dartmouth Student Group Health Plan, pay for the procedure (full coverage, up to $350).

While the abortion-rights lobby has been notably silent over RU-486 in Hanover, debate has ensued at other schools since the FDA's approval. Officials have discussed dispensing the RU-486 regimen at the University of Southern California, the University of California at Berkeley, Pennsylvania State Universities, and other schools.

Yet, in the near future, few will do so. Despite the seeming simplicity of RU-486—presumably anyone can administer a pill—and the often-vocal demand for it, colleges have mostly left unchanged their abortion policies, and the majority of campuses continue to favor Dartmouth's approach. By referring students to local abortion providers instead of performing the procedure on campus, colleges avoid unwelcome publicity and conflict—protests, vigils, leaflets, and mailings.

Most colleges that do not already offer abortions are similarly declining to offer RU-486, citing lack of equipment and facilities. 'Most college health centers do not provide any surgical procedures,' Tara Torchia, sexual health coordinator of the University of Maryland, told the Michigan Daily.

Beyond the lack of capable facilities and the fear of bad publicity, college administrators have a more paramount concern: student safety. Despite nearly 20 years of use in Europe and Asia, RU-486 is still plagued by safety issues. As noted above, the pill is not always effective; in such cases a surgical abortion must be performed for the mother's and, in a sense, the fetus's well-being.

Though it comes in pill form, RU-486 requires more care and consideration than aspirin. It cannot be self-administered and requires the oversight of a physician. Because the RU-486 regimen consists of three treatments over the course of about three weeks, women taking it who live in dorm rooms or sororities are left at potentially greater risk than those choosing surgical abortion, who, in a hospital or clinic, are under a doctor's care for the duration of the procedure. 'I'm not sure it's an ideal method for a college student,' said Dr. Herbert Jones of the Charlottesville Center for Reproductive and Sexual Health. 'It doesn't really work with drop-in patients.'

Further, women with bronchitis, high blood pressure, menstrual irregularity, or allergies cannot take the pill because of the risk of severe bleeding . The drug's other side effects include heart palpitations, infection, nausea, diarrhea, vomiting, and painful cramping.

Quality issues also affect the pill's safety. Supplies of RU-486 are imported into the United States by Danco Laboratories, which then resells the drug as 'Mifeprex.' The pills originate in Shanghai, China, where they are manufactured by the Hua Lian Pharmaceutical Plant, which copied the drug's formula from its French inventor in the 1980s. Concerns exist over impurities and the homogeneity between batches. Troubling many, China refuses to grant the FDA access to statistics on domestically produced RU-486. American women may be receiving an inferior, more dangerous version of the pill than that available in Europe.

Further, a second drug, misoprostol, sold by Searle as 'Cytotec,' that is used 48 hours after mifepristone to induce contractions and expel detached fetal tissue, has in recent weeks been the subject of great debate within the medical establishment. Six weeks before the FDA approved RU-486, Searle sent a letter to physicians warning against the use of Cytotec by pregnant women. According to Searle, the drug may cause uterine ruptures or death. Many hospitals have since suspended their use of Cytotec—in effect abandoning RU-486 as well. Further, bills before the U.S. House and Senate, sponsored by Rep. Tom Coburn and Sen. Tim Hutchinson, respectively, would restrict the use of the two drugs in tandem.

Finally, other schools refuse to distribute the pill for ethical, not merely logistical, reasons. 'We don't advise on abortions, we don't do abortions, [and] we don't give out contraceptives,' explained Marianne Worley of Georgetown Hospital of Georgetown University, which has a Jesuit affiliation. Florida Atlantic University health chief Cathie Wallace states that RU-486 is 'abortion...not contraception,' when explaining why it won't be available on campus to FAU students.

Student demand for RU-486 is also questionable. Currently, the full regimen costs between $450 and $750. In comparison, a surgical abortion costs $350 to $550. Although the price of the abortion pill is expected to decrease as its distribution rises, surgical abortion will likely still be a cost competitive alternative. Students especially may dislike that RU-486 requires multiple physician visits and takes several days to expel fetal tissue. Also, the pill can only be used in the first seven weeks after conception; the time-frame in which surgical abortions can be performed is limited only by law and medical willingness. Many women fearing pregnancy forestall the post-implantation abortion dilemma by taking the 'morning-after pill,' or emergency contraception, which is available on many campuses.

So far, only one school has stepped forward and confirmed that it will provide RU-486 treatment (although others, such as Dartmouth, may do so through associated teaching hospitals). Yale has long been at the forefront of the Ivy League in performing abortions on campus, and the university plans to maintain its cutting edge status by offering the pill to students. 'It's just a continuation of our existing policy to offer the full range of services that are legal, including the termination of pregnancies,' said Tom Conroy, a Yale spokesman, to the Chronicle of Higher Education.

Yale historically has informed few of its abortion policy, in the past denying to reporters their availability. Caroline Barber and Yevgeny Vilensky, presidents of the Reproductive Rights Action League and the Pro-Life League at Yale, respectively, only learned of the school's plans to offer RU-486 when asked for comment by a Chronicle reporter. Conroy defends the university's obfuscation in its own literature. 'It doesn't have 'appendectomy' in there either.'

Moreover, all Yale students, not just those who have enrolled in a particular health plan, subsidize on-campus abortions through a mandatory health services fee. While Harvard, like Yale, will reimburse students for surgical or drug-based abortions (which are performed mostly at the university's Brigham and Women's Hospital), the school has agreed to refund to objecting students the portion of their health fee that would otherwise fund abortions. Conroy justifies Yale's refusal to implement a similar policy by means of analogy: 'Male students can't say they don't use gynecological services so they shouldn't have to contribute to the cost of other members of the health plan.' It's unknown what proportion of Yale students ethically oppose gynecological services.

Although, as noted, the Dartmouth Student Group Health Plan will pay for students' abortions, spreading these costs across the student pool, the group plan is voluntary—students may opt out, substituting their own coverage. Interestingly, 'termination of pregnancy' is the only procedure covered under Dartmouth's plan when used as secondary coverage that requires no claim to be filed with the primary provider. For a student who is primarily covered under her family's plan, this exemption,if exercised, would hide abortion-related claims from her parents.

For all its controversy, RU-486 has hardly rippled, let alone splashed, the Hanover politic, and for good reason. Dick's House Health Services estimates that Plan B, the brand of emergency contraception dispensed by Dartmouth, is administered between 200 and 250 times, annually, to students. Dick's House refers between twenty and twenty-five students, annually, to abortion providers. Few of the former cases, an unknown number of which might have developed into pregnancy, are candidates for RU-486. Of the latter cases—those students who have sought referral for abortion—the number who will choose RU-486, if and when it is available, is likely to be negligible, given the treatment's duration and complications, and the health community's unfamiliarity with it.

For college students, at least, RU-486, mifepristone, is not the easy, uncomplicated, abortion-on-demand pill that its critics feared it would be. It is just another alternative and, like all means of abortion, an unattractive one at that. Corrie Callaghan, a junior at Ohio University and self-identified feminist, concurs. 'The abortion pill does not increase women's choices,' she wrote in an Ohio University Post editorial, 'it simply adds to the variety of ways they can achieve one choice.'

Colleges' New Abortion Question

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