Mifepristone and Misoprostol: WHO Endorses Safer Abortions Despite U.S. Interference
NOTE: The following is one of a series of case studies produced by the Union of Concerned Scientists' Scientific Integrity Program between 2004 and 2010 to document the abuses highlighted in our 2004 report, Scientific Integrity in Policy Making.
In March 2005, a World Health Organization (WHO) expert committee unanimously recommended that WHO, the world's leading health body, add two abortion pills to its Essential Medicines list. Final approval of committee recommendations is usually a quick formality, but in this case strong pressure by the U.S. government to block the listing of the abortion pills delayed final action for four months.
The WHO estimates that 19 million women have unsafe abortions annually, almost all of which occur in the developing world.¹ Each year, about 68,000 women die from these unsafe abortions. Many others have complications from surgical abortions leading to "reproductive tract infections (RTIs), chronic pelvic pain, pelvic inflammatory disease (PID), and at times to infertility."² According to an editorial in the British medical journal The Lancet, "WHO's own reproductive health strategy, approved by the World Health Assembly in 2004, identifies elimination of unsafe abortion as one of five priorities, which will also help to achieve the Millennium Development Goal for reduction in maternal mortality."³
It was with these facts in mind that a WHO expert committee recommended that the organization place the two abortion pills on its list of Essential Medicines, a list "which constitutes official advice to all governments on the basic drugs their doctors should have available."4 The expert committee, after reviewing evidence from 39 trials, ruled that mifepristone (also known as RU-486) followed by misoprostol is "effective, safe and convenient in inducing medical abortion until nine weeks of pregnancy."5 The medications have been licensed in the UK since 1991 and in the US since 2000.
While WHO's choice of medicines to be endorsed for the Essential Medications list is supposed to be based on science, the London newspaper The Guardian reported that the U.S. Department of Health and Human Services lobbied to dissuade the WHO from approving the medications on ideological grounds.6 The recommendation of the expert committee conflicted with the Bush administration's ideological stance on abortion. As the delay in the drugs' approval wore on, leading reproductive health experts contacted WHO Director-General Lee Jong-wook and expressed concern that the global organization might "bow to political pressure."7 As one consultant to the expert committee told The Lancet, "WHO was established to be above single-state politics and it would be a gross error if such an influence were allowed to intrude."8
After a four month delay, mifepristone and misoprostol were eventually added to the Essential Medicines list, albeit with additional language stating "Where permitted under national law and where culturally acceptable."9 However, the incident stood as one more example of the Bush administration's willingness to override the recommendations of medical committees and scientists. This example is in line with the Bush Food and Drug Administration's repeated delays in approving the contraceptive "Plan-B" as an over-the-counter medication, in spite of scientists' recommendations that it be approved.
1. World Health Organization, “Unsafe abortion - Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2000,” 4th edition, 2004. Accessed December 7, 2006.
2. Ibid, 4.
3. “Abortion Drugs Must Become WHO Essential Medicines,” The Lancet, 28 May 2005, accessed 16 October 2006.
4. Sarah Boseley, “U.S. Accused of Trying to Block Abortion Pills,” Guardian, 21 April 2005, accessed 16 October 2006.
5. “The Selection and Use of Essential Medicines,” Report of the WHO Expert Committee, World Health Organization, 2005, accessed December 7, 2006.
7. The Lancet.
9. WHO Expert Committee, 37.