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France-USA: The Complicated Life of the Abortion Pill

Monday 11 July 2022, by siawi3


The Complicated Life of the Abortion Pill

RU-486 was developed by a Jewish scientist, born Étienne Blum, in Strasbourg, France. He took the name Émile Baulieu upon joining the French Resistance. Baulieu and his invention have faced vitriolic resistance from the anti-feminist extreme right.

July 8, 2022

Lauren Collins
The New Yorker

In March, a Republican lawmaker named Danny Bentley took the floor of the Kentucky House of Representatives to advocate for a bill that would strip many forms of reproductive-health care from residents of the state. A pharmacist and one of the bill’s sponsors, Bentley promised to clear up some “misconceptions” about RU-486, or mifepristone—a synthetic steroid that is the critical ingredient of the abortion pill, a two-dose regimen that allows people to safely end early-stage pregnancies without surgical intervention. Bentley claimed that RU-486 was created during the Second World War, and that it was initially called Xyglam B—an apparent reference to Zyklon B, the lethal gas used in concentration camps. “The person who developed it was a Jew,” Bentley said, adding that the inventors were likely motivated by “making money.”

The abortion pill was created in the nineteen-eighties; mifepristone was the 38,486th molecule developed by the French drug company Roussel-Uclaf, hence the name RU-486. It was never called Xyglam B or Zyklon B. Bentley’s fabulations were likely inspired by anti-abortion groups that have long tried to exploit a tenuous link between the two products: Roussel-Uclaf was owned by a German company that once belonged to another German company, a subsidiary of which helped manufacture and sell Zyklon B.

Bentley was correct, however, that RU-486 was developed by a Jewish scientist. He was born Étienne Blum, in Strasbourg, in 1926 and took the name Émile Baulieu upon joining the French Resistance in the nineteen-forties. As Étienne-Émile Baulieu, he led an extraordinary life: dodging Fascist paramilitaries; hobnobbing with art-world luminaries; enraging the Pope; and, in the course of a seven-decade career in biochemistry and neuroscience, becoming a seminal figure in the fight for reproductive rights. Last month—exactly two weeks before the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization overturned Roe v. Wade—I visited Baulieu, known as the father of the abortion pill, in his office, in Paris. He told me that he wasn’t much bothered by misrepresentations, such as Bentley’s, of his legacy. (Bentley apologized for his comments after complaints from anti-defamation organizations.) He had absorbed worse: the Vatican once denounced RU-486 as “the pill of Cain: the monster that cynically kills its brothers.” Baulieu’s policy had always been to brush it off. But he was deeply troubled by the threat to reproductive freedom in the United States. “It’s scandalous,” he said. Later, he wrote to say that the Dobbs decision “calls into question a fundamental right of women that we would have thought was legally, politically, and morally guaranteed.”
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Bentley’s bill passed the Republican-dominated Kentucky legislature easily, but was temporarily blocked by an injunction in federal court. For the moment, abortion remains legal in the state; however, Republicans are supporting a ballot measure that would amend the state constitution to make it harder to challenge these laws in court.

The abortion pill—not to be confused with the morning-after pill, which delays ovulation, is typically taken in two stages. First, mifepristone blocks the body’s receptor for the hormone progesterone, thereby disrupting the gestation process in its early stages. Misoprostol then provokes contractions so that the uterus expels what’s left of the pregnancy, causing heavy bleeding and cramping. (According to Planned Parenthood, medication abortion feels, for most people, “like having an early miscarriage.”) In 2020, medication abortions accounted for an estimated fifty-four per cent of reported American abortions, making it, for the first time, the most common means for ending pregnancies in this country.

According to some experts, mifepristone has been overregulated since it was approved for use in America, particularly “given the very low rate of adverse events associated with its use.” During the pandemic, the F.D.A. suspended a rule requiring health-care professionals to dispense the medication in person—a change that the agency has since made permanent. Abortion pills can be taken at home, so those who need them may not require transportation, child care, or significant time away from work or school. They are safe, effective, and can be mailed or passed around, making them relatively difficult for authorities to trace. As my colleague Jia Tolentino has written, abortion pills are “among the reasons that we are not going back to the era of coat hangers.”

Greer Donley, a scholar of reproductive justice at the University of Pittsburgh’s law school, told me, “Historically, abortion was done by procedures, which meant that, if you could control doctors, you could really control abortion provision. But now that abortion pills exist, a state’s abortion ban is not going to have the same effect as it used to.” Baulieu’s so-called little white bombshell doesn’t remedy the injustice and inequity of the Court’s decision. But it is now the most powerful tool available to the estimated thirty-three million Americans whose reproductive autonomy the ruling attempts to negate.

I visited Baulieu at his research facility, inserm Unit 1195 at the Hôpital Bicêtre, on the southern outskirts of Paris. The antechamber to his office was lined with brightly colored binders (“Abortion,” “Menopause,” “Ethics Committee”) and folders containing decades’ worth of press clippings (“Furor Over Award for Abort-Doc Pill, Pro-Lifers Rip ‘Human Pesticide,’ ” the New York Post wrote, in 1989). On a desk sat a glass container that had once held pâté and was now used to store paper clips.

The doctor appeared wearing gray slacks, a white button-down, and a bluish-gray sport coat. He used a walking stick, but, at ninety-five, he is otherwise in good shape. He has spent the latter part of his career studying depression and Alzheimer’s. He has also investigated the anti-aging properties of the hormone dehydroepiandrosterone (DHEA), without conclusive results, but he doesn’t rule out a positive influence. “I take it every day,” he said, leading the way to his office.

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Long tipped for the Nobel Prize for his work on mifepristone, Baulieu never won it, but he has collected nearly every other honor a scientist could imagine, ranging from the Lasker Award to the presidency of the French Academy of Sciences. In 1989, during a visit to Baulieu’s office, the Times reporter Steven Greenhouse noted Baulieu’s “breezy, almost brash manner and hyperkinetic nature,” which gave him “the air more of a populist politician than of a meticulous medical researcher.” Although he has mellowed since then, Baulieu hasn’t entirely lost the savvy, self-assured persona that made him, in the words of one French journalist, one of the great “public enemies of the Catholic, anti-feminist, extreme right.” Plaques, memorabilia, and piles of books commingled in his office with bulbous sculptures by the feminist artist Niki de Saint Phalle. “I lived with her,” Baulieu said casually, taking a seat near a window that overlooked a former prison where the Marquis de Sade was once held. He didn’t mention Sophia Loren, whom he once drove around in an Austin Morris, fleeing paparazzi. (In the nineties, Vanity Fair reported, over Loren’s denials, that they became involved in an intense affair, causing Baulieu’s wife to remark, “What could he do? He fell in love.”)

Baulieu was conceived on the Nile—he knows this because his parents honeymooned there while his father, Léon Blum, a specialist in kidney disorders, was in Egypt treating King Fuad I for diabetes. During the First World War, Léon, an Alsatian, had been drafted into the German Army. Concocting a medical pretext, he asked officers to submit urine samples by mail. He used the postmarks to track their movements, which he transmitted to the French, who then recognized him with a Legion of Honor when the war was over. Léon died when Baulieu was three. His mother—a lawyer, pianist, and friend of the suffragettes who had “felt hemmed in by Alsace” and by Léon’s professional life—moved the family to Paris. “I was allowed to think about any career I wanted,” Baulieu later wrote. “Except medicine.”

When Hitler’s Army occupied France, in 1940, Baulieu was a teen-ager. He joined the Communists, distributing anti-German pamphlets and narrowly avoiding capture as he shot at German cars and delivered arms. In November, 1944, he was part of a group of ex-resistants who kidnapped Charles Marion, a Vichy official who was in prison awaiting trial, and executed him. “The prefect conducted himself with dignity, dressed in a beautiful loden coat that I never forgot,” Baulieu later recalled in “Libre Chercheur,” a book-length conversation with the journalist Caroline Fourest. As the youngest member of the group, Baulieu was assigned to shoot photos, rather than fire at Marion. He ultimately considered the killing “justifiable in the context,” but remained haunted for years by other horrors he witnessed, such as the forced shaving of women accused of collaboration.

Eventually, Baulieu felt drawn to his father’s profession. He threw himself into medical studies, eating bananas for every meal “to go faster,” and quit the Communist Party after the Soviet invasion of Hungary, in 1956. He recalled, “The best way to help society, I felt, was at the level of the individual.” Later, he loved Primo Levi’s work on the integrity of science, which he paraphrased as, “Science has an essential virtue. It respects what is.”

Baulieu’s first major discovery involved DHEA, the hormone to which his work would later return. Secreted by the adrenal glands, DHEA plays a key role in manufacturing both testosterone and estrogen, and DHEA levels can serve as an indicator for certain diseases. Other scientists, searching for a detection technique, had tried examining the oily fluids from the adrenal glands. Baulieu tried to measure it by looking at the water-soluble form, likening his method to “probing a vinaigrette: looking in the vinegar instead of the oil.” His discovery made him a tenured professor by the age of thirty. Soon, he was headed to New York, for a yearlong fellowship at Columbia University’s medical school. (He had to wait for Kennedy’s election to get a visa, given his Communist past.) While in the U.S., Baulieu got to know Gregory Pincus, the inventor of the oral contraceptive pill, who became a mentor. By night, he ran around with a group of striving New York artists: Jasper Johns, Robert Rauschenberg, Frank Stella. “Like them, I was adding form to a blank space with only vague notions of where it would lead me,” Baulieu later wrote of his research.

Before long, Baulieu decided to focus on sex hormones. He chose them expressly because of their social implications, hoping that they would yield new possibilities for reproductive autonomy and for alleviating the “pain and punishment” that had long been the lot of those who chose to end a pregnancy. (“Teach her a lesson she’ll remember,” he’d once heard a surgeon say, instructing his assistant to forgo an abortion patient’s anesthesia.) “My intention was to give women a choice that, through a pill, respects their privacy and physical integrity and allows them to totally avoid the aggression of surgery,” he told me.

Baulieu came up with the idea to create a molecule that would effectively impersonate progesterone, occupying the uterus’s progesterone receptors and thus preventing it from retaining a fertilized egg. “Rather than disrupt a pregnancy with a sharpened spoon or a suction tube, why couldn’t the natural process be reversed by altering the balance of the same hormone that caused it to begin?” he explained. The top executive at Hoechst, Roussel-Uclaf’s parent company, was an ultraconservative Catholic who opposed abortion, so, in company meetings, Baulieu focussed on other potential applications for his new product, suggesting that, because anti-progesterones can inhibit the production of cortisol, it might be a great thing to give astronauts to control stress. After several months of experimentation, the in-house chemist at Roussel-Uclaf succeeded in synthesizing RU-486. In clinical trials, the drug, paired with its contraction-inducing partner, had a success rate of nearly a hundred per cent.

Baulieu had previously served on a government committee (made up of thirteen male doctors, assisted by two female secretaries, he recalled) that helped push through the legalization of birth control in France. He knew that public positioning would be important to RU-486’s success. The ability to end a pregnancy by medication was revolutionary for patients (“The Pill that Changes Everything,” read a cover of Time magazine), and it would also be more palatable than surgery to some of the constituencies policing their reproductive choices. Baulieu called his scientific breakthrough “contragestion,” a method that occupied “the middle ground between preventing fertilization and surgically removing a fetus.” He became one of the most prominent advocates for RU-486, sometimes to the annoyance of colleagues, who accused him of hogging the spotlight. Always willing to vulgarize his work in the name of wider understanding, he used various metaphors to explain how the medication worked—jamming a radio signal, creating a false key—but the simplicity and elegance of mifepristone hardly needed illustration. For Baulieu, it was “the œuvre I dreamed of with artist friends in New York.”

The fight to bring RU-486 to market was brutal and nonlinear. French authorities approved the drug for sale in September of 1988, amid an already febrile atmosphere. The next month, in Paris, Catholic extremists set fire to a movie theatre showing Martin Scorsese’s “The Last Temptation of Christ,” while others deployed tear gas in a screening of Claude Chabrol’s “Une Affaire de Femmes,” a film based on the life of Marie-Louise Giraud, a laundress from Normandy who was guillotined by Vichy authorities on July 30, 1943, for having performed twenty-seven abortions. Facing pressure from the Catholic Church and threats of a boycott, Roussel-Uclaf wavered. “You are turning the uterus into a crematory oven!” read a sign that one protester brandished outside a shareholders’ meeting. Less than a month later, having already promised to supply RU-486 to a number of countries, the company decided to pull it from the market.

Baulieu heard about the decision from a lab technician who burst into his office to relay the news. He soon took off for the World Congress of Gynecology and Obstetrics in Rio de Janeiro, which, upon his arrival, effectively transformed into what the New York Times described as a “pep rally” for RU-486. Within days, the French government, which held a thirty-six-per-cent stake in Roussel-Uclaf, intervened, threatening to force the drugmaker to cede the patent for RU-486 to another company. Roussel-Uclaf reversed its decision and put the drug back on the market, preparing the way for worldwide distribution. The French health minister declared, “From the moment government approval for the drug was granted, RU-486 became the moral property of women, not just the property of the drug company.”

America was especially fraught territory for RU-486—an enormous free market with deep-seated sensitivities. Faye Wattleton, who served as the president of the Planned Parenthood Federation of America from 1978 to 1992, told me that she made three trips to Paris to try to persuade company officials to make the pill available to her group for clinical trials. “I think Roussel-Uclaf was uncomfortable with their product being released to our organization, if you want my opinion,” she said. “There was a fair amount of squirming in their seats.” At first, some proponents pitched the drug as a contraceptive, suggesting that it could be taken in the final days of one’s cycle to prevent unwanted pregnancy. Still, news of the drug “arrived like a splash of gasoline on a blazing fire,” Baulieu recalled. He threw himself into the fray, briefing F.D.A. specialists and allying with activists. (He didn’t have a financial stake, not being entitled to the drug’s profits under his consulting agreement with Roussel-Uclaf.) Once, in New Orleans, he was scheduled to give a talk but switched slots with another speaker. He was sitting in the auditorium among a crowd of pediatricians, listening to the other speaker, when a small bomb went off. “Boom!” he later recalled. “Those pro-life idiots didn’t even notice that we had changed the presenter and the theme!”

During the Reagan and Bush years, RU-486 was a banned substance and federal research into it was largely forbidden. At one point, activists set up a makeshift lab in a New York suburb, where an anonymous volunteer scientist who went by Dr. X tried to manufacture the pill using information gleaned from the patent application. The parent company of Roussel-Uclaf refused to sell the drug in America and declined to partner with Planned Parenthood, Wattleton told me. She added, “What if they gave it to an organization headed by a Black woman and it blew up in their face?” she said. Eventually Roussel-Uclaf transferred the U.S. rights to a nonprofit organization. “I believed from the beginning that RU-486’s eventual destiny would be shaped in the United States,” Baulieu wrote, citing the country’s history as the birthplace of oral contraception alongside its high rates of teen-age pregnancy.

Over the objections of such figures as the congressman Robert Dornan (“The taking of a pre-born life will be as easy and trivial as taking aspirin”) and Dr. John Willke of the National Right to Life Committee (“We’re really very simplistic, visually oriented people, and if what [abortions] destroy in there doesn’t look human, then it will make our job more difficult”), the F.D.A. finally approved RU-486 in 2000, making it available to Americans a decade later than their peers in countries such as China, Russia, and the U.K.“Ideology and machismo, alas, weigh more heavily than rationality and scientific proof,” Baulieu said, when I asked if he had drawn any lessons from that fight. “A method that makes the termination of pregnancy less physically traumatic for women and less risky to their health has always been rejected by pro-lifers: what they really seek is to harm and punish women.”

Four decades after its invention, the abortion pill is more important than ever. “It’s a method that the person who needs the abortion can use to self-manage an abortion,” Elisa Wells, a co-founder of Plan C, an organization that provides information about at-home medication abortion, told me. “So there’s no clinician or gatekeeper, and no permission is really needed to exert control over their own reproduction.”

Exactly how powerful medication abortion will be in subverting abortion bans will depend on how readily people can access it. According to the Kaiser Family Foundation, eighty per cent of American adults, including two-thirds of women aged eighteen to forty-nine, don’t know that medication abortion exists. Even those who do may not possess sufficient financial or technological means to get it. Already, Black and Hispanic people, teen-agers, and people who live in rural areas face disproportionate difficulty. “There are those who say, ‘Well, we can pass it in the mail,’ ” Wattleton said. “I say to them, ‘Have you heard of the Comstock laws?’ There will be a thousand ways to Heaven—or to Hell—to figure out how to frustrate every effort for women to control our bodies.”

The legal status of abortion pills will be fiercely contested now that Roe has fallen. Last week, Attorney General Merrick Garland said that states cannot ban mifepristone, but the matter is unsettled. Pro-choice lawsuits are likely to pursue the preëmption theory, invoking the supremacy clause of the Constitution to argue that the F.D.A.’s rulings take precedence over those of state authorities. But abortion is a time-sensitive process—the F.D.A. has approved RU-486 for use only within the first ten weeks of pregnancy—and pills, especially when procured through online pharmacies or international providers, can take weeks to arrive. Moreover, women have been prosecuted both for managing their own abortions and for selling abortion pills. The coming “War on Abortion Drugs,” as the Brookings Institution described it, is likely to be “as racist and classist” as the war on narcotics. Donley, the reproductive-justice scholar, said that she sees increasing criminalization and the likely targeting of providers and helpers—a mother who procures abortion medication for her teen-age daughter, for example—as the major post-Roe obstacle to accessing medication abortion. “Unfortunately, there is no risk-free option for people who are living in states that ban abortion and who seek abortion care,” she said.

In recent years, providers and activists have been devising new ways to distribute abortion pills. Aid Access, a service run by Rebecca Gomperts, a Dutch physician who has helped provide abortions in international waters, has also experimented with robots and drones as means of delivering mifepristone and misoprostol. After an online consultation, Gomperts sends a prescription to a pharmacy in India, which ships the pills directly to the patient. Since Gomperts is licensed and based abroad, she is beyond the scope of American law enforcement. “Unjust laws should not be respected,” Gomperts has said.

In states where medication abortion is legal, startups such as Hey Jane and Choix are trying to do for abortion pills what Warby Parker did for eyeglasses, making them convenient, affordable, fast, and unintimidating. Hey Jane, for example, offers “modern abortion care”—a text, phone, or video consultation with a medical provider, followed by the delivery of pills in an unmarked box—for medically eligible patients over eighteen in New York, California, Washington, Illinois, Colorado, and New Mexico. (Contraindications to medication abortion include the presence of an ectopic pregnancy, chronic adrenal failure, and inherited porphyria.) The price is two hundred and forty-nine dollars, less than half of the average cost of treatment at a clinic. Other providers propose advance provision of abortion pills: getting them to people as a precautionary measure so that if an unwanted pregnancy occurs, the pills will be on hand. (The pills have a shelf life of around two years.) A recent editorial by researchers at the University of California, San Francisco advocates this approach, arguing that “the model would effectively shorten the time between the decision to have an abortion and obtaining care to zero days.”

For residents of states that restrict abortions, accessing medication abortion will be harder and riskier, but still possible. For the moment, it is legal, if expensive and time-consuming, to travel to another state and receive abortion pills there. (Some states are already preparing legislation to try to prevent patients from crossing state lines.) Just the Pill, a telehealth abortion provider that advertises “Abortion Delivered,” plans to dispatch mobile-abortion clinics—bulletproof trucks with pills, as well as vacuum-aspiration devices—to the Texas border. “People will use creative methods to obtain these medications that are approved by the US Food and Drug Administration and which are so easily available to their counterparts across state borders,” Abigail R. A. Aiken and Ushma Upadhyay write in the British Medical Journal. They cite workarounds such as virtual mailboxes that allow a person in, say, Oklahoma to have pills delivered to California and then forwarded to their actual home. Faced with the threats of surveillance by the government and harassment from anti-abortion activists (for example, in the form of Web sites for fake clinics), patients are also turning to the kind of face-to-face community networks that have insured reproductive autonomy from the beginning of time.

In 1989, Baulieu was optimistic about the future. “You can’t hold back scientific progress,” he said. “You can’t put it back in the drawer.” His faith endures, even as lawmakers do just that. “It is up to scientists and doctors to always continue to invent new methods and to pursue progress,” he told me. When Baulieu created RU-486, one politician called it a “death pill.” Now, it is a critical means for preserving American lives, and American life as we have known it since Roe.


Lauren Collins has been a staff writer at The New Yorker since 2008. She is the author of “When in French: Love in a Second Language.”

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