Comment & Reviews
By Clare Murphy
This month has seen decisions taken in both Britain and Germany
which give women in these countries greater means to control
their fertility. Here in Britain, British Pregnancy Advisory
Services (BPAS), has introduced a system where women can obtain
a packet of emergency contraceptive pills, 'the morning after
pill', to keep at home in the event of an accident, rather
than waiting until the accident has happened. In Germany,
the abortion pill RU 486, which can be taken to terminate
an unwanted pregnancy in the first trimester and which has
been available here since 1997, has finally been approved.
These are both good decisions. Recent research has shown that
the sooner the morning after pill is taken after unprotected
sex, the more effective it is. Women can experience great
difficulties getting an appointment with a doctor at short
notice, particularly at weekends and especially at Christmas,
and what about when accidents occur on holiday? GCSE French
may have equipped you with the necessary vocabulary to order
your croque monsieur, it may not be quite as useful for explaining
to a French doctor, if you get that far, what happened to
you the night before with a real monsieur. I have a friend
who has just returned from studying abroad with a story of
negotiating her way around the Polish health service using
a series of unladylike but necessary gestures to explain her
predicament. It was a lengthy procedure, amusing in retrospect,
she said, but horrendous at the time.
Following a consultation with a doctor to check her medical
history, a woman can go home with a single set of pills, saving
herself a great deal of panic and anxiety as well as giving
her a better chance of not falling pregnant, if and when an
accident should occur.
For German women, the recent ruling on RU 486 is also a positive
step. Women who would rather not undergo invasive surgery
now have access to an alternative means of ending an unwanted
pregnancy. RU 486 contains a drug called Mifepristone which
stops the production of progesterone, the female hormone active
in maintaining pregnancy. When this hormone is eliminated,
the lining of the womb disintegrates. 48 hours later the woman
returns to the clinic or hospital to take a prostaglandin,
which brings about the expulsion of the contents of the womb,
and the abortion is complete.
To my mind, any moves which help women deal with either the
possibility or the reality of an unwanted pregnancy, should
be welcomed. But I'm consistently surprised to find voices
quite outside of the anti-choice lobby which are not quite
as welcoming. Inevitably organizations such as LIFE, the ardent
anti-abortionists who think sex without procreational intent
is wrong anyhow, had a few things to say about easier access
to the morning after pill. Although the morning after pill
is not an abortifacient, in that there is no fetus to speak
of being destroyed, they contend easier access will simply
encourage more unprotected sex.
And they are joined in that outlook by others from more liberal
circles. Derek, a young investment banker told me his fears.
"Women are vulnerable," he says. "And if men know that the
woman he's with has got a couple of pills in the cupboard
that will 'sort it out', he's likely to behave in an irresponsible
manner. Obviously women should be able to get it in emergencies,
I just don't think it should be too easy. Otherwise it's bound
to be misused." Sarah, a 23 year old art student agrees. "I'm
worried that it will be used as a normal form of contraception.
And that's definitely not what it's meant for. It should be
relatively hard for women to get hold of it."
Should it? We seem to have a bad habit of knowing that we
behave sensibly, but are sometimes doubtful of others' ability
to do so. "Why on earth would you regularly use it as a form
of contraception?" said one young woman, a little more trusting
than some of her contemporaries. "It can make you throw up,
it can give you a really bad headache. But so can being pregnant,
which would be the alternative! But it's funny that people
talk about it encouraging irresponsibility. I reckon it's
actually pretty responsible to keep something like that at
home, just in case." The fear of things just being made a
little bit too easy for women has been very clear in the coverage
of the introduction of RU 486 in Germany. The drug has been
accepted for use by the Federal Institute for Medicine and
Medical Products and will be introduced on the market in October
of this year. The idea of swallowing a pill to terminate a
pregnancy doesn't sit comfortably with a nation that has constructed
a very elaborate abortion law, Paragraph 218, which makes
women jump through a series of administrative hoops before
being permitted an abortion.
German women have to undergo a session of obligatory counselling
and satisfy the counsellor in question that she has thoroughly
thought through her decision, before being sent home for another
compulsory week to keep thinking, to be followed up by another
session of counselling. The counsellor will then issue her
with a certificate permitting an abortion to be carried out.
At no point in the sessions is the counsellor allowed to indicate
any approval for a decision against continuing with the preganancy.
The Catholic Church in Germany has used the occasion to once
again condemn the practice of abortion and has labeled RU
486 'the pill of death'. No surprises there. But doctors from
the German Union of Gynaecologists and representatives from
Pro Familia, the national family planning organization, have
clearly felt the need to allay fears among the general public
that RU 486 simply makes abortion too easy. They have spoken
extensively about the psychological stress of experiencing
in a conscious state an abortion, as well as the physical
side effects such as nausea and cramps. And they have repeatedly
stressed the fact that women wanting RU 486 will by no means
be able to bypass the administrative and counselling structures
already in place.
Wolfgang Straube, one of the doctors who pioneered tests in
Germany at a clinic in Greifswald said in an interview with
the Berlin Tagesspiegel: "It won't be the easy option. Through
taking a pill a woman is active in the procedure rather than
passive. It means she's taking some responsibility for what
she has done. That's a good thing."
This is an odd thing to say. If a patient with heart disease
took pills would we all nod approvingly because he's taking
responsibility for his condition? Such a suggestion wouldn't
even enter our minds. And while it may be true that some women
may still by preference opt for a simple surgical procedure,
with the PR the abortion pill has received, it makes you wonder
why they have introduced it at all.
German women who choose to use RU486 will suffer greater discomfort
than other European women anyway. A dosage of RU 486 is always
followed 48 hours later by a prostaglandin to expel the contents
of the womb. How painful this process is fully depends entirely
on the type of prostaglandin used. Cytotec has to date been
the preferred choice of doctors who administer RU 486 abortions,
which causes pain not much greater than a menstrual cramp.
This won't be on offer to German women however. The company
that produces Cytotec in Germany, Heumann Pharma, has explicitly
stated that it will not permit the preparation to be used
for abortion purposes. "We don't want to play any role in
these abortions," said the director of Heumann Pharma, Wolfgang
Niedermaier, to Taz, a Berlin daily. There are business rather
than moral concerns at issue. Heumann Pharma is a daughter
company of the American pharmaceutical giant Searle.
In the States, where the abortion debate is actually physically
fought with clinics bombed and doctors murdered, commercial
enterprises fear the repercussions of supporting the practice
of abortion. Hoechst Marion Roussel, the company created by
the merger of the respective German, American and French companies,
suffered large financial losses in the States due to Roussel's
involvement with RU 486. American anti-abortionists organized
a successful boycott of a number of the firm's products. Searle
is keen not to incur similar losses.
While the ruling by Heumann Pharma won't mean that doctors
are entirely prohibited from prescribing Cytotec, they would
be doing so at their own risk, so that if anything were to
go wrong, they would be wholly liable. Understandably in an
age of law suits that makes them rather reluctant.
At the end of the day, what we seem to be saying is this.
Whether it is obtaining the morning after pill or having an
abortion, it's right that women who've had unprotected sex
should experience some level of difficulty. To teach them
a lesson, to make it clear to them that what they've done
isn't an acceptable form of behaviour. Whether it was an accident
And we do this out of a false sense of morality. The idea
is that women are their own worst enemies, and we need to
put barriers in their way to stop them behaving recklessly.
Perhaps we should have a little more confidence. I believe
women are very capable of making good decisions about their
own bodies and their own lives, and that they are indeed the
best people to make those decisions. It is not moral to set
up an obstacle course for a woman who find herself in what
can be very traumatic circumstances. It is moral to make sure
she has access to the services she needs as quickly and painlessly