R U - 486 BIRTH CONTROL?
Nancy Gettman and Deborah L. Vosler
1992 Woodrow Wilson Biology Institute
Minimum of two class periods.
To introduce the uses, effectiveness, cost, advantages, disadvantages or
contradictions, and ethical issues concerning birth control devices. RU-486,
known as the French Abortion Pill, will be featured in this activity.
Obtain as many birth control devices as possible:
Condoms (male & female), Birth Control Pill, IntraUterine Device (IUD),
Spermicides (Foam, Gel, Film, Suppositories, Cream), Diaphragm, Sponge,
Scalpel to portray sterilization, Cervical Cap, Hormone Releasing Capsule,
Latex Plug, Douche, Syringe to indicate long-term Injectable Hormone,
Calendar to portray the Rhythm Method, 1/2 inch Plastic Tubing to signify an
Induced Abortion, Empty Gelcap to represent RU-486
1 Paper lunch sack for each contraceptive type
Empty paper lunch sack to depict Abstinence
Caution students concerning proper handling of the scalpel.
- Place each birth control device in a separate paper lunch sack. Fold the
tops down and staple each sack closed.
- Give each student a sack containing a different birth control device and
instruct them to open their sacks. Students may work together or
individually depending on the number of students and/or the number of birth
control devices obtained.
- Each student or group of students will research the background information
regarding their specific birth control device. NOTE: After obtaining the
various birth control devices, DO NOT discard the enclosed information sheet
as this may be a valuable reference material.
*Suggested areas of student research include:
A) How does this birth control device work?
B) What is the effectiveness of the birth control device?
C) Determine the cost of each birth control device for one month, one
year, a reproductive life cycle.
D) Describe advantages and disadvantages/contradictions for the birth
E) What impact has this birth control device had on society con-cerning
- Each student or group of students is responsible for providing a written
and oral presentation.
- Distribute the case study to each group of students. Using a
collaborative learning process, students will consider and discuss the
ethical issues presented. Refer to "A 3-D Case Study".
Assistance For Attached Case Study:
- Summarize each birth control device with emphasis on RU-486.
- Present the case study to the class. Suggestions include:
A. Discussion with the entire class.
B. Dividing the class into cooperative learning groups.
C. Having students work alone.
D. Using role playing techniques.
E. A panel presentation having students determine the role that each will take.
F. A panel presentation having students take an opposing viewpoint.
G. Videotaping the class for further discussions.
H. Setting up a debate.
I. Being creative!
- Available Methods of Birth Control
- Future Methods of Birth/Fertility Control
- RU-486 Addendum
- A 3-Dimensional Case Study
Extensions And Activities:
- This activity may lead to the ethical issues of abortion. You may want to
introduce the history, legalities, techniques used, Roe vs. Wade, etc.
- Invited Guest Speakers:
A. Social workers
B. Clergy from various denominations
D. Planned Parenthood
- Suggested Field Trips:
A. Planned Parenthood
- Samples of the various birth control devices may be obtained (often free)
by contacting Planned Parenthood, medical agencies, pharmacies, company sale
- Suggested Video Material:
A. Children Having Children (CBS, 1990)
B. Teenage Sexuality (ABC News, Ted Koppel)
C. China's Only Child (Nova)
D. Teen Contraception (AIMS MEDIA)
E. Check catalog from State's Health Department
AVAILABLE METHODS OF BIRTH CONTROL
|Method of Birth Control||Preg/100|
(estrogens and progesterone)
|3 - 6
||Inhibits secretion of FSH, LH: prevents follicle maturation and ovulation
||Decreases menstrual pain and blood flow, lowers risk of PIDs &
allows for sexual spontaneity||Weight gain, moodiness, water retention,
breast tenderness, prescription required|
|Diaphragm with Spermicide||2 - 25||Blocks and kills
sperm||Protects against STD, viable for 6 hours||Lack of
spontaneity, MD administration|
|Intrauterine Device - IUD||1 - 6||Prevents or terminates
implantation||Allows sexual spon-taneity, effective up to six years
||Pelvic infection, excessive bleeding, physician placement|
|Condom - Male and Female||3 - 36|
2 - 15
||Inexpensive, protects against STD||Some loss of sensation
Male & Female
Fertilization prevention||"Safe, " allows for sexual
spontaneity||Surgical risks, irreversibility|
|Hormone Releasing Capsule||<1||Inhibits secretion of
FSH, LH: prevents follicle maturation and ovulation||Protection lasts
2-5 years, fertility return next cycle, may reduce endometrial cancer||
Surgical risks, weight gain, menstrual irregularities, mood changes|
|Sponge with Spermicide||6 - 20||Blocks and kills sperm
||24 hour protection, reduces risk of STD||Irritation, yeast
|Rhythm||10 - 47||Abstinence during time of ovulation
||Knowledge of cycle changes||Requires motivation|
|Douche||? - 85||Washes out sperm in the vagina||
Restores pH, acts as a cleansing agent||May force sperm into uterus
|Foam/ Film/ Gels/ Suppositories/ Creams||3 - 30||
Kills sperm and may act as a barrier||Protects against STD, inexpensive,
effective with barrier methods||Irritation, waiting period up to 4
hours, needs reapplication|
|Cervical Cap with Spermicide||4 - ?||Blocks and kills
sperm||48 hour protection, reduces risk of STD||Irritation, lack
of spontaneity, MD|
|RU-486: "The French Abortion Pill"|
|20 - 35|
4 - 10
|Blocks action of progesterone
and provokes uterine lining to slough off the embryo||Effective up to 7
wks after egg is fertilized, may be used to treat a number of different
cancers and/or diseases||Small risk of excessive bleeding, physician
administered in three office visits|
|Induced Abortion||0||Abortifacient: removal of embryo
||100% effective||Surgical risks, excessive bleeding||Total abstinence||0||Refraining from sexual activity
|Latex plugs||0 - ?||Temporary physical blockage of
fallopian tubes||Allows for sexual spontaneity, highly effective||
Accidental removal, irritation, physician administration||Injection Hormone: Depo-Provera||<1||Inhibits
secretion of FSH, LH: prevents follicle maturation and ovulation||Lasts
1-3 months, fertility return by next cycle||Physician administered,
moodiness, weight gain
FUTURE METHODS OF BIRTH/FERTILITY CONTROL
- Biodegradable implants that do not require surgical removal
- A 2-year pregnancy vaccine
- Male contraceptives that reduce sperm count
- Chemicals for nonsurgical sterilization
- Development of female and male sterilization techniques that will be more
- Oves Disposable Cervical Cap
- Lea's Shield (silicone barrier)
- Unisex Condom Garment
- Fem Cap
To develop, test, and evaluate the safety of a new contraceptive, it
generally takes 15 or more years and at least $50 million. Despite the
importance of population control, annual worldwide expenditures on
reproductive research and contraceptive development have declined from a high
of $250 million a year to $200 million a year today � an average of only 25
cents per person (Hanna 47).
At the present, the four most widely used methods for preventing pregnancy
include sterilization, IUDs, oral contraceptives, and condoms. Injectable
contraceptives and hormonal implants are also being used in some countries.
RU-486 is a drug with substantial market potential that is not likely to
be available in the United States in the near future. This delay in access to
what many consider a proven drug is primarily due to the boycott threats and
effective private and public sector lobbying of United States anti-abortion
organizations (Hanna 43). Like the birth control pill, RU-486 has encountered
strong resistance from moralists who fear it will trivialize sex, life, and
human relations by "bolster[ing] the comparison between taking the drug
and swallowing aspirin" (Glasow 7). Although there are many sectors
against the use of RU-486, the Feminist Majority Foundation is funding efforts
to bring the "French birth control pill," RU-486, into the United
States. Individuals are making donations as high as $10 million to promote
the use of this drug for research and as an abortifacient (Zeman 8).
RU-486 is not the only contraceptive drug held hostage to the abortion
debate. The most advanced contraceptive, Human Chorionic Gonadotrophin (HCG)
vaccine, has been tested by the World Health Organization (WHO) in Australia,
the Dominican Republic, Finland, and India. It has not been tested in the
United States because it acts by stimulating the immune system to attack the
outer cells of the pre-embryo. Thus, abortion opponents classify it as an
abortifacient rather than a contraceptive, although it works on embryos prior
to implantation (Foreman, 1989).
Besides being safer than aspiration abortions and causing fewer side
effects, RU-486 is relatively inexpensive. Tests on 8,000 women have shown
that the drug has a very small risk of causing excessive bleeding. An
abortion performed by a private physician in the United States costs between
$500 and $2,000. Clinics usually charge $200 - $300 for the service. In
France, the cost of an abortion using RU-486 is approximately $235. This
includes the RU-486, the prostaglandin, and three medical visits (Abrams,
RU-486 causes an abortion by blocking the action of the hormone
progesterone, thus provoking the uterine lining to slough off the embryo.
Used alone, it is about 80 percent effective in preventing implantation of a
fertilized egg if taken within five weeks after a missed period. If taken
with a small dose of prostaglandin, a substance that makes the uterus contract,
it is 95 percent effective up to five weeks after a missed period. After
seven weeks, it is not very effective. After counseling and at least a one
week waiting period, the pregnant woman receives a dose of RU-486 from her
physician and must return two days later to insure a complete abortion.
The prospects for RU-486 in the United States are dim. At best, it could
be available by 1997. It is unlikely that this drug will be legally available
to women in the United States because of intense opposition from pro-life
groups fearing that it will make abortions commonplace. Government-funded
researchers are not allowed to test RU-486 or to develop other abortion
drugs. No company has expressed interest in marketing RU-486 in the United
States because of such pressure and fear of possible liability suits.
A 3-DIMENSIONAL CASE STUDY
What are the ethical and legal implications of the following
- I. RU-486 is a controversial drug that is now widely used in France to
terminate pregnancies. The FDA has blocked the use of this drug in the United
States as an abortifacient. RU-486 interferes with the implantation of
fertilized eggs in the uterus by binding tightly to the progesterone receptors
in cells. Hormone regulating birth control devices (e.g. The Pill) use
progesterone and estrogen to masquerade a "pseudo" pregnancy.
When accompanied with prostoglandin, a progesterone antagonist such as
RU-486 stimulates the changing of the endometrial lining of the uterus, thus
provoking a rejection of the embryo. A decline in the progesterone level
increases the contractibility of the muscles of the uterus and leads to a
softening and dilation of the cervix which results in a sloughing off of the
As a society we have approved the use of other forms of birth control
that function in much the same way as RU-486. The intrauterine device (IUD)
may act as an abortifacient by irritating the endometrial lining of the
uterus. Further, the removal of the embryo by induced abortion is performed
by dilation and aspiration in the first trimester.
- Why has the acceptance of RU-486 become a problem in the United
- Should RU-486 be approved as an abortifacient in the United States? Why
or why not?
- Suggest some guidelines, policies and points-of-view for or against the
approval of RU-486.
- II. RU-486 could be approved in the United States for non-abortion
purposes. Having many promising applications, it has shown potential
usefulness in dilating the cervix to help avoid cesarean sections and aiding
in the delivery of a fetus that has died in utero. It is effective in the
treatment of certain cancers that contain progesterone receptors including
some breast and ovarian cancers. It has also been used to treat endometriosis
(the third leading cause of infertility in the United States), Cushing's
syndrome (a hormonal disorder in both men and women that is currently
responding to the removal of the adrenal glands), some ulcers, hypertension,
obesity, and osteoporosis.
- Assuming no law exists to handle RU-486, now what points would you include
to regulate such testing and results? Why?
- If your mother has a type of breast cancer that could be treated with
RU-486 and you could bring this drug illegally into the United States, what
would you do? What ethical issues would the doctor have to encounter?
- III. Leona Benten, a pregnant, unmarried 29-year old California woman
is challenging the Government's ban on importing RU-486. Ms. Benten obtained
RU-486 in Europe and hoped to self-administer it to end her almost eight weeks
of pregnancy. On July 1, 1992 at Kennedy International Airport, government
agents seized the drug from her when she was trying to bring it into the
country. The Supreme Court asked the Justice Department to explain why the
government should not return the abortion drug to her. The officials of the
Food and Drug Administration (FDA) believe that the case raises the issue of
whether the agency has broad discretion to regulate the importation of
- What would you do if you were the FDA official in charge of this case?
- What was Ms. Benten's motive in bringing the drug to the United States
even though she knew of the governmental ban?
- What should Ms. Benten do at this point?
- If you were Ms. Benten's attorney, how would you argue this case?
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Carey, John and Jonathan B. Levine. "Can the 'Abortion Pill' save
lives?" Business Week 17 December, 1990: 56-57.
Findlay, Steven and Muadi Mukenge. "A user's guide to 14 methods.
" U.S. News & World Report 108 (1990): 62-63.
Foreman, J. "Abortion: An American Divide" Boston Globe
23 April, 1989: 1.
Glasow, R. "RU-486: The Prostaglandin Connection."
National Right to Life News 13 December, 1990: 7.
Green, Mark. "RU-486." The Nation 252 (1991):
Hall, Elizabeth. "When Does Life Begin?" Psychology Today
Sept (1989) 42-46.
Hanna, Kathi E. Biomedical Politics, Division of Health Sciences
Policy Committee to Study Biomedical Decision Making. Washington D.C.:
National Academy Press, 1991.
Hilts, Philip. "Thomas Expedites Suit on Abortion Pill."
The New York Times 16 July 1992: A18.
Kieffer, George. "Bioethics." Lecture. Academic Director,
Woodrow Wilson Institute on High School Biology, Princeton University. 5-31
Lewin, Tamar. "Woman at Center of Debate: Model of an Ardent
Feminist." The New York Times 16 July 1992: A18.
Miller, G. Tyler Jr. Living in the Environment: An Introduction
to Environmental Science. California: Wadsworth Publishing Company
Seligmann, Jean. "A Condom for Women Moves One Step Closer to Reality.
" Newsweek 119 (1992): 45.
Ulmann, Andre', George Teutsch and Daniel Philibert. "RU-486."
Scientific American 262 (1990): 42-48.
Zeman, Ned and Lucy Howard. "Help for RU-486." Newsweek