While the drug Mifeprex (also known as RU-486) won its first battle in September when it was approved by the Food and Drug Administration (FDA), a new stream of controversy has sprung up over its use at universities. Many college health service centers, including Tufts', do not have the full-range facilities mandated by the FDA for distribution of the drug, and have opted to direct students seeking to terminate a pregnancy to outside sources.
The FDA's restrictions on the drug's distribution reflect the health complications that sometimes accompany medically induced abortions. The pill is not available through a regular prescription, and its usage requires up to three doctor visits _ two for distribution and one follow-up. The procedure has two phases: The first step lowers the patient's progesterone levels to stop embryonic growth. Next, the uterus contracts, essentially forcing a miscarriage.
RU-486 can only be administered in the first five weeks following a woman's last menstrual period, and most campus health providers say they lack the costly ultrasound equipment that is necessary to determine an exact date of conception.
"I think it was pretty tough getting it past the FDA," Tufts Health Services Medical Director Margaret Higham said. Tufts will offer the drug on campus because the Health Services facility does not meet even the most minimal of the FDA's requirements. "We don't have ultrasound or gynecology," Higham said. "We will refer students to outside sources for surgical or medical termination."
Instead, Health Services will refer students to the Planned Parenthood Clinic in Boston for medically induced abortions in the same way that it currently refers students seeking surgical abortions. Tufts will continue to provide counseling to pregnant students.
"Our responsibility is to help them understand their choices, and to work with them as they evaluate their choice within the parameters of their own belief system," Higham said. "We then direct our patients to the best source of care to carry out the treatments they choose."
Members of the Tufts community who frequently advocate women's rights on campus say that Health Services made the right decision, given the resources it offers. Others aren't sure that Tufts should even consider distributing the drug, claiming it promotes unprotected sex.
"While I support RU-486 100 percent, I am weary of its distribution in the college sense," Tufts Feminist Alliance co-chair Abby Moffat said. "If a college student were to get pregnant, the means by which she could receive a medical abortion are out there _ but to offer it so close to home could easily appear an encouragement for unsafe sex."
Harvard University opted not to offer Mifeprex through its health services, though its facilities do meet some of the FDA's specifications. According to Harvard officials, there have been documented cases when the pill was ineffective, forcing practitioners to perform emergency surgical abortion procedures. The FDA does not require that surgeons be available where RU-486 is distributed, but employees at Harvard's health services said that the doctor who dispenses RU-486 should, if necessary, be the one to perform the surgical abortion.
Professional abortion counselors say that political, rather than medical, reasons may be behind colleges' hesitancy toward distributing the drug. "There are a lot of politics around the drug being available," said Shateia Whitney, a counselor from Daybreak Pregnancy Resource Center. "[Offering it] forces a school or university to take a political stand, and maybe they're trying not to do that."
Harvard's decision sparked disagreement among various segments of the university. An editorial last week in the Harvard Crimson, a student newspaper, argued against the school's judgement.
"The benefits of RU-486 lie in its flexibility and privacy, but the restrictions on its distribution limit what the community can gain from the new drug," the paper wrote. "A reversal of Harvard's decision not to offer RU-486 in Holyoke Center would grant students additional privacy and one more avenue through which they can choose to have an abortion."
Barrett said she understands why Harvard students are upset about the unavailability of the drug on campus, if in fact, the lack of surgical abortion services is the reason why the university is holding back. "I would be upset, too _ I see no reason not to offer it if they could. To make them go to outside clinics would be difficult."
Yale University has long offered surgical abortions on campus, though it has never advertised the procedure. In the near future, Yale will begin dispensing RU-486 at its campus health center. But most college campuses will likely follow policies similar to those at Tufts and Harvard and refer students to local Planned Parenthood clinics.
"I can see why a university wouldn't want to offer yet; they may just not feel comfortable," Whitney said. "It's wise for them to be cautious _ when they refer they're not taking full responsibility" for medical complications.
Most campuses offer the "morning-after pill" as an emergency contraceptive, which Higham joked "should be over the counter."
Whitney said she anticipates that more campuses will soon offer RU-486 through their health centers. "The drug is still very new, maybe they're saying 'no' for now, but they're also saying 'wait'."
Though Tufts will not offer Mifeprex on campus, Higham said she is curious to observe its lasting effects.
"It's a good alternative," she said. "I'm interested to see how it plays out medically."
