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  RU486 in Germany
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 or not.

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 as possible.
 
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