In Canada, most abortions are done through the manual vacuum aspiration method or by dilation and evacuation. While there are also other surgical abortion options, medical abortions can be used to terminate early pregnancies. Medical abortion is when drugs are used to empty the contents of the uterus, without surgery. The most common form of medical abortion is called RU-486 (or Mifepristone). The name RU-486 comes from the French pharmaceutical company Roussel-Uclaf who invented the drug. RU-486 can be used within the first 9 weeks of pregnancy. To date, RU-486 has not been approved for use in Canada. The most common form of medical abortion combines two medications, mifepristone and misoprostol. Mifepristone blocks the hormone progesterone, which is needed to maintain the pregnancy. Without progesterone the lining of the uterus breaks down and sheds (as it does in a regular menstrual cycle). The second medication, misoprostol, contracts the uterus to expel the pregnancy usually within 6 to 8 hours, in the privacy of the home. A follow-up exam is scheduled for two weeks later to make sure the process is complete. Most of the side effects when using this early abortion option are caused by the second medication, misoprostol. Side-effects may include heavy bleeding, headache, nausea, vomiting, diarrhea, and heavy cramping. The abortion pill is safe. According to Dr. Ellen Wiebe's clinical trials, fewer than one percent of women who take the drug combination experience heavy bleeding that requires further treatment*. In clinical studies, incomplete abortion only occurred in 2-3% of cases. If pregnancy is continued after taking these medications, there is a high risk of fetal deformities. Therefore, most doctors will require that a woman sign an agreement that if the medical abortion does not occur, she will have a surgical abortion. However, the need for this is quite low since medical abortions work in almost every case. According to studies of the American Food and Drug Administration and the National Abortion Federation (based in the USA) there are no long-term risks associated with having used mifepristone and misoprostol. After using the Abortion Pill, women may pursue another pregnancy whenever they feel the time is right. In July 2005, the World Health Organization (WHO) included the combination of mifepristone and misoprostol on its list of medicines that are essential to good health because it is a safe way to terminate an unintended pregnancy and to save women’s lives. In developing countries, access to medical abortion has saved many women from having to access unsafe and clandestine surgical abortions. RU-486 is available in all countries of the European Union except Portugal, Italy and Ireland. It is also available in the United States, China, India, Russia, Australia and South Africa, among others. Unfortunately, RU-486 is not legal in Canada. Many opponents raised concerns about its safety because of the possibility to cause Clostridium sordellii infections and septic shock. Four women passed away from septic shock after taking Mefiprex in 2004. All four women were in California and investigators are looking into common conditions that link these four women’s experiences together. It is important to note that C sordellii infections do not only happen with medical abortion. The infections can occur in other situations such as following childbirth (vaginal delivery and caesarean section) and after pelvic or abdominal surgery. Other known cases of C. sordellii have occurred in males and females of varying ages and under non-obstetric conditions. Other conditions that have been known to cause this infection include umbilical infection, deep skin infection, tendon transplant surgery, orthopedic surgery and infection following motor vehicle accidents. This proves that the infections are not a direct consequence of medical abortion alone. Research done by Gynuity Health Projects show that serious infection following medical abortion is rare. Approximately 460,000 women in the U.S. have used mifepristone for medical abortion since the year 2000. The proportion of all reported infections among women during the first 18 months following their use of mifepristone was low at only 0.013%. RU-486 has been used in France since 1988 and there has been no evidence of complications. Overall, it is recognized as a safe option for women who want to terminate an unwanted pregnancy. The only form of medical abortion that is available in Canada is a conjunction of methotrexate and misoprostol. Methotrexate is usually given by injection. Misoprostol tablets are placed in the vagina five to seven days after the methotrexate injection is given. It causes the muscles of the uterus to contract, pushing out the contents. In most cases the uterus will be emptied within 24 hours but in about 35 percent of cases, it can take several days or weeks. Pain medication can be used to ease the pain of the cramps, which occur when the pregnancy tissue comes out of the uterus. If the medical abortion does not cause the body to expel the pregnancy tissue, birth defects are likely to result. Therefore, a woman who takes these drugs must be prepared to have a surgical abortion if the medical abortion is unsuccessful. A follow-up exam is done one or two weeks after the methotrexate injection to make sure that the abortion has happened. Medical abortion is available from only a few abortion clinics and should be taken in the first 7 weeks of pregnancy. For more information on Medical abortion and infections, visit: http://www.gynuity.org/documents/FAQsCSordelliiinfectiontechnicalversionENG.pdf http://www.womenshealthmatters.ca/Centres/sex/abortion/medicalab.html http://www.fwhc.org/abortion/medical-ab.htm * Wiebe, Ellen et al. "Comparison of Abortions Induced by Methotrexate or Mifepristone Followed by Misoprostol." Journal of the American College of Obstetrics and Gynecology, vol. 99, No. 5, Part 1, May 2002, 817.