A Contested Pill: Transnational Controversies over Medical Abortion in Germany,France,and the United States

On 23 September 1988, French pharmaceutical company Roussel Uclaf introduced Mifepristone (RU 486), a drug to induce abortion, to the French market. But immediately after its release, local antiabortion activists sent death threats to the company's executives and their families. The activists equated the development of Mifepristone with the production of Zyklon B, the pesticide used in Nazi concentration camps. Their comparison was potent because Hoechst AG, the German parent company of Roussel Uclaf, was the legal successor of IG Farben, the chemical conglomerate that had produced Zyklon B, employed forced laborers, and conducted human experiments during the Holocaust. In Germany, Hoechst AG also received boycott threats that contained photographs of dismembered fetuses and compared them to dead bodies in the crematoriums of Auschwitz. ¹

Because of these threats, Hoechst AG and its French affiliate decided to withdraw the drug from the markets on 26 October 1988. Only after the French government intervened two days later was Mifepristone made available in France. Over the next five years, the controversy over the abortion pill grew global in scale as it involved pharmaceutical executives and national governments, as well as international organizations and civil society actors, in a multifaceted controversy. ²

The case of the abortion pill offers insight into the transnational dimension of antiabortion mobilization and the role of Holocaust comparisons within the movement. The events surrounding the market introduction of Mifepristone took place at a time when historians and West German intellectuals were debating the meaning and the uniqueness of the Holocaust. ³ Since the TV miniseries Holocaust had aired in 1979, publications on the involvement of medical professionals in the Nazi crimes had an impact beyond academic circles and led to a rethinking of Germany's coming to terms with its past. ⁴ In 1986, the principle was established in German public discourse that the Holocaust was unique and that German responsibility for it should not be relativized by comparing it to other historical events – a principle that the antiabortion movement consistently violated.

This article examines the history of medical abortion in the late 1980s and early 1990s against the backdrop of the entanglements between contemporary history and biomedicine. It adds a transnational dimension to the existing scholarship on the political meaning of the abortion pill by putting the West German and French perspectives in dialogue with the well-studied US-American case. ⁵ My article takes the frequent Holocaust comparisons among opponents of medical abortion seriously and presents the German actors’ discomfort with their country's past as a new perspective for analyzing the controversy. It shows that the uncovering of the Hoechst predecessor's controversial alliance with the Nazi regime not only coincided with the first failed market introduction of Mifepristone but that it actually undermined the cultural and political opportunities for introducing a medical abortion method in the late 1980s.

My investigation uses an approach developed in social movement sociology to analyze the political opportunity structure for the market introduction of medical abortion and the rallies against it. Sociologists Leslie King and Ginna Husting adopted this theoretical approach from Myra Marx Ferree and her team, who investigated discursive opportunity structures that influenced abortion discourses in Germany and the United States. ⁶ According to Ferree, a political opportunity structure refers to ‘all of the institutional and cultural access points that actors can seize upon to attempt to bring their claims into the political forum … The discursive opportunity structure is limited to the framework of ideas and meaning-making institutions in a particular society’. ⁷ In addition to looking at discursive frameworks, King and Husting investigated the cultural structures of French and US-American societies to explain why direct action protests in front of abortion clinics were a more successful strategy in the United States than in France. I follow a similar trajectory by investigating cultural and political access points that connected the debates on the legacy of the Holocaust with the protests against Mifepristone. ⁸

My investigation in this article goes beyond a structural analysis as it follows a transnational approach that considers the transatlantic journey of the abortion pill. Both activists in favor and against medical abortion crossed borders in their endeavors. Nevertheless, the nation-state remained a key reference point as activists’ motives and agendas were influenced by national policies and cultural mores. My transnational approach, therefore, traces the circulation of abortion knowledge among activists in all three countries under the shadow of the changing perceptions of the Holocaust. This means that I neither write a medical history of Mifepristone nor do I add to the rich history of the antiabortion movement. Instead, I use the controversy as a gateway for understanding the specific entanglements between historiographical research and the controversial nature of biomedicine. My approach prompts me to argue that the US-American antiabortion movement's exploitation of the West German discomfort with its Nazi past affected the delay in medical abortion's market introduction globally. My approach also leads me, in the second part, to suggest that a transnational coalition of feminists, public health officials, and family-planning activists countered these impediments by invoking the political opportunity structure of free-market capitalism.

I derive my arguments from a reading of archival material generated by social movements and contemporary public media reports. Unfortunately, Hoechst AG did not allow me to access their company archives. Instead, I relied on source material by abortion-rights activists, antiabortion groups, and family-planning associations in Germany, France, and the United States as those actors were central to either impeding or enabling Mifepristone's market introduction. ⁹ Because of restricted access to archival material, I will deduce the pharmaceutical industry's interests and Hoechst's motivations from historiography and contemporary news media reports.

The abortion-pill controversy has been studied in Science and Technology Studies (STS) ever since its first failed introduction to international markets in 1988/1989. Alta R. Charo and Kathi E. Hanna's 1991 Political History of RU-486 is based on a wide range of publicly accessible source material covering public media reports and activist literature to create a timeline of events as they unfolded in the United States and France. Based on the same source material, Adele Clark and Theresa Montini argued in 1993 that the medical abortion controversy was not a two-sided question but a multifaceted debate with various actors interpreting the abortion pill as a stand-in for multiple societal concerns. The controversy, according to Clark and Montini, created multiple constructions of RU 486, ranging from its celebration as a means of women's liberation or a breakthrough in science to a warning against the dangers to women's health and ‘direct link to Nazi death camps’. ¹⁰

Recently, historians of science have examined the history of abortion pills in different national settings. Morag Ramsey's recent PhD dissertation traces the history of the ‘Swedish abortion pill’, showing that an interest by state actors and the WHO led to an initial breakthrough in the use of prostaglandins, steroid-like compounds that induce labor, as abortifacients. Ilana Löwy and Marilena Cordeira Dias Villela Corrêa tell a different story for the case of Brazil, where the synthetic prostaglandin Misoprostol became the most popular method for illegal self-induced abortions. Other researchers have looked at how the availability of medical abortion changed the reproductive landscapes in countries where abortion (until recently) remained illegal, such as Ireland and Poland. ¹¹

Even though France and Germany were central to the medical abortion controversy, there is surprisingly little research on these two national cases. For France, activist-scholar Fiammetta Venner considers protests against RU 486 in her study of the antiabortion movement in the context of the new radical right. For the German case, historical studies have been limited to the Cold War context for medical trials in East Germany. Led by Florian Steger, a research group on medical trials by Western pharmaceutical industries in East Germany focuses its analysis of RU 486 on the question of medical ethics and the governmental regulations that were involved in enabling medical research in a socialist country. They excavate the interests pursued by Eastern European governments when taking part in medical trials sponsored by the World Health Organization (WHO). ¹²

The rich literature on the US-American abortion controversy has often bypassed the history of medical abortion because, as historian Johanna Schoen has pointed out, it differs very much from the history of surgical abortion. ¹³ Recent publications on the antiabortion movement in the United States have focused on the role of the religious right, women in the movement or the use of strategies from the new left and imagery of the fetus in protests. ¹⁴ Heather Munro Prescott considers the possible use of RU 486 as emergency contraception in her monograph on the morning after pill. She uses Clark and Montini's methodological approach to unpack the multifaceted character of medical abortion and highlights that even in the ‘pro-choice’ movement there were different voices ranging from white feminists who embraced Mifepristone as a technology to expand reproductive choice to Black feminists and women's health activists who feared that medical abortion was yet another unproven technology tested on minority women's bodies. ¹⁵

Ever since Jeffrey Epstein's groundbreaking study on HIV/AIDS activism revealed the entanglements between social movements and biomedical advances, historians have followed two distinct positive narratives. The first, established by Epstein himself, is about patient advocacy groups that pressured the release of medication to speed up the biomedical advance. ¹⁶ The second narrative shows how the feminist and consumer movements were critical of the safety of biomedical inventions and pushed for more regulation of reproductive technologies, making them safer in the process. ¹⁷ Recently, however, historians have begun to criticize the mainline feminist movement for being too white and middle class. White feminists initially welcomed new reproductive technologies, such as oral contraceptives and IUDs, because they increased women's options in determining their own reproduction. ¹⁸ But Black and Chicana feminists in the United States raised awareness that long-term contraceptives offered greater technological opportunities to exploit minority women. As a consequence, in the 1990s, feminists began to demand ‘reproductive justice’ instead of ‘reproductive choice’ (a term associated with consumerism). ¹⁹ The new terminology reflected that access to reproductive technologies was governed not just by laws but by their intersection with the categories of ‘race’ and ‘class'. It highlighted that access to safe abortion was not just a matter of legal rights or economic choice but a matter of civil rights and social justice. ²⁰

In the debates about Mifepristone, minority feminists frequently criticized white American feminists represented by the National Association for Women (NOW) for prioritizing individual choice over the concerns of Black and poor women. ²¹ Yet, NOW representatives were the ones who could use their social and cultural capital to negotiate a solution that made Mifepristone available to German and American women in the late 1990s. As this article will show, they negotiated questions of individual rights and economic profits within a capitalist medical system, where pharmaceutical companies naturally pursued profits. Activists learned to frame their demands within these economic coordinates. Although they aimed for emancipation, their promotion of medical abortion as a matter of individual choice rather than public health or human rights confirmed a capitalist market logic. The invention of the abortion pill, in other words, was intertwined with public history and transnational protests as well as the economization and individualization of medicine. ²²

Scientists had tried to develop a medical abortion method since the 1960s when family-planning campaigns and research into contraceptive methods took place under a ‘population control paradigm’. That discourse alleged that population growth, especially in the Global South, would lead to famine, political unrest, the rise of communism, and perhaps another world war. ²³ In 1965, researchers at Karolinska Institute in Stockholm, Sweden, achieved promising results in a first-phase trial to medically induce abortion with a chemical compound named F6103. ²⁴ At that time, abortion was still illegal in most Western European countries and was only allowed under very strict guidelines in Sweden. Two years later, Britain reformed its abortion laws. The state of New York legalized abortion in 1970, while the US Supreme Court declared abortion restrictions in individual states unconstitutional in 1973 (Roe v. Wade). East Germany legalized abortion in 1972, France in 1975, and West Germany enacted a reformed abortion law in 1976. With the global rise of the second-wave feminist movement, abortion was now debated as an issue of women's rights and public health. ²⁵ Meanwhile, former population control advocates, such as German family-planning activist Hans Harmsen, believed that an abortion pill would be even more revolutionary than oral contraceptives as it would save thousands of women from dying from sepsis or internal bleeding after botched surgical abortions. ²⁶ For that reason, the WHO and the New York–based Population Council in 1971 began to sponsor research on medical abortion methods. ²⁷

The journey of the abortion pill took up momentum in 1980, when a team of chemists and endocrinologists led by Émile-Étienne Baulieu at Roussel Uclaf developed RU 486, the chemical component of Mifepristone. The team had originally sought to create a contraceptive that women needed to take only once a month, regardless of whether they had conceived. ²⁸ RU 486 works as an anti-progesterone agent. It is not a hormone but an artificial compound that blocks the uterine receptors from receiving the hormone progesterone, which is necessary for maintaining the uterine lining after a fertilized ovum is implanted. When progesterone is blocked, the uterine lining dissolves and the embryo is discarded. Mifepristone on its own causes miscarriages in 80 per cent of cases when taken in the first eight weeks of pregnancy. If taken together with prostaglandin, a hormone-like compound that induces labor, the chances of inducing a miscarriage rise to 96 per cent. If combined with Misoprostol, a synthetic version of prostaglandin originally intended to treat stomach ulcers, Mifepristone is 99 per cent effective. ²⁹

After the success of Baulieu's team at Roussel Uclaf, international organizations coordinated medical trials for RU 486. Sponsored by the Population Council, researchers at the University of Southern California in Los Angeles conducted the first small trials in 1983. Second-phase trials coordinated by the WHO took place at hospitals in Switzerland, Sweden, Hungary, and East Germany. ³⁰ From 1986 to 1988, Roussel Uclaf provided free samples of the drug for third-phase trials at clinics of the French family-planning association MFPF (Mouvement Français pour Le Planning Familial). For the WHO, medical abortion was an important public health issue, especially in the Global South, as it promised to prevent the deaths of up to 115,000 women in low-income countries. ³¹ Supporters of medical abortion assumed that it could lower fatalities from surgical abortions since it did not require general anesthesia and limited the risk of perforation of the uterus and infections from unsterile instruments. Moreover, medical abortion did not require the physician administering the drug to receive special training, either.

In contrast, family-planning campaigners and mainline feminists in the Global North hoped that medical abortion could be cheaper for their patients since it did not require a hospital stay. They also hoped that it could de-escalate the abortion controversy, something that Cory Richards and Rachel Benson Gold, staff members of the Planned Parenthood-affiliated Guttmacher Institute in New York pointed out when imagining the future of abortion:

A woman walks into her doctor's office and receives a prescription. At home, she takes a pill and, just hours later, is no longer pregnant. She has had an early abortion – in complete privacy – with no picketers, no protesters and no politicians involved. Surgical abortion is virtually a thing of the past. ³²

Since RU 486 could also be administered as a kind of morning-after pill before the implantation of a fertilized egg, legal scholar Gwendolyn Prothro hoped in 1997 that the abortion pill might ‘break the abortion controversy deadlock’ in the United States. ³³

But medical trials established a protocol that actually required more visits to a clinic than surgical abortion. After three women experienced cardiac arrest as side effects of the prostaglandin during third-phase trials in France, family-planning clinics mandated that a patient first undergo a medical check-up to make sure that she did not have any underlying preconditions such as high blood pressure, diabetes, or heart disease. Seven days later, she could come back to the clinic to take Mifepristone, and 48 hours after that she had to come back again to be administered prostaglandin under medical supervision to make sure she did not exhibit any side effects. The patient could leave after three hours to experience the miscarriage at home but had to return to the clinic one week later to check that all tissues had been expelled. This meant that women still could not have abortions by themselves and without medical supervision. Nor would abortion become easier on their bodies as women could expect cramping, nausea, and heavy bleeding for up to 10 days after taking Mifepristone. ³⁴

After the trials, Roussel Uclaf released Mifepristone to the French market in 1988 but withdrew it after company executives received death threats. As mentioned above, Roussel executives feared for the safety of their families since protesters two years earlier had committed arson attacks on hospitals providing abortion in France. ³⁵

Hoechst AG also feared boycotts against its American affiliate Hoechst-Roussel. Although the German pharmaceutical conglomerate owned 60 per cent of Roussel Uclaf shares, and both companies together owned the American subsidiary, the French state was a minority shareholder in Roussel Uclaf. Francois Mitterrand's socialist government, intent on holding up women's rights and the principle of laicité against pressure by the Catholic clergy and far-right extremists, used a legal loophole to nationalize the patent and make Mifepristone available in French family-planning clinics. Minister of Health Claude Évin explained in his 2006 autobiography that his intention for the move was to offer women a gentler alternative to the ‘trauma of surgical intervention with a D&C abortion’. In a press conference at the time, he declared the abortion pill to be ‘la propriété morales des femmes’. In English, his phrase ‘the moral property of women’ would soon become a slogan used by American NGOs, feminists, and historians alike. ³⁶

Roussel Uclaf initially decided to distribute the new pill in France and Britain only, where the NHS offered it from 1991 without much controversy. ³⁷ In China, a generic version of the drug was tried and released through the WHO in 1988. Even though East Germany had taken part in medical trials and West German family-planning activists had a great interest in medical abortion, the company was reluctant to release the drug in West Germany as it feared antiabortion protests as severe as in France. ³⁸ As mentioned above, a transnational antiabortion movement that connected activists in the United States, West Germany, and France led the protests against medical abortion in the late 1980s. In the United States, a single-issue antiabortion movement had evolved since 1968 when grassroots initiatives united to form the National Right to Life Committee (NRLC). Since the early 1970s, the antiabortion movement, which in the beginning was mainly white and Catholic, relied on protest forms established by the new social movements. ³⁹ It adopted strategies such as civil disobedience and sit-ins and hijacked the demand for ‘informed consent’ from the feminist movement. ⁴⁰ Its key assumption was that life began at conception and that any form of abortion was murder.

In 1971, Catholic gynecologist Jack Wilke and his wife Barbara published their Handbook on Abortion, the first publication to use photographic images of aborted fetuses as antiabortion propaganda. ⁴¹ The book also compared abortion to the Holocaust and slavery. The Wilkes demanded that doctors who performed abortions should be tried for crimes against humanity according to the standards invoked at the Nuremberg Trials. ⁴² By comparing legal abortion to the most horrific crimes against humanity, activists such as the Wilkes not only underscored their belief that life began at birth but they also accused anyone performing a legal abortion of being a war criminal, a fascist, and an adversary of liberal democracy. ⁴³ The assumption that abortion was murder justified former counter-culture activist Terry Randall to found Operation Rescue, a protest group that tried to prevent abortions by disrupting the operation of clinics by blocking sidewalks, committing arson attacks, or physically attacking personnel. ⁴⁴ For antiabortion activists, the Holocaust comparisons established a direct link between the heroism of American soldiers during World War II and protesters performing arson attacks.

Pamphlets and photographs of dead fetuses were reprinted in countless high-quality brochures and translated into 15 languages, including German and French. ⁴⁵ Such publications became important resources for an emerging transnational antiabortion movement. According to historian Prudence Flowers, in 1983 the American antiabortion movement shifted towards ‘exporting the abortion war’ abroad. Activists were frustrated by domestic developments after President Ronald Reagan's antiabortion stance turned out to be a campaign promise without any follow-up in actual legislation. In their new global strategy, they protested against NGOs that supported China's One-Child-Policy. ⁴⁶ In 1984, their agitation resulted in the U.S. government's Mexico City policy (also known as the Global Gag Rule), which cut American funding from international NGOs that counseled women on legal abortion. After that, activists founded international interest groups such as Human Life International and International Right to Life. ⁴⁷ In this context, La Trêve de Dieu, the French counterpart of Operation Rescue, appeared in 1988 as a close ally of Human Life International. Its leader Thierry Lefévre took part in a month-long sit-in in front of an abortion clinic in Wichita, Kansas. ⁴⁸

Even though militant direct-action protests against clinics had little effect in France, ⁴⁹ the movement's Holocaust analogies were readily accepted there. The French ‘mouvement provie’ dated back to the 1890s when Catholic activists protested against Neo-Malthusianism, the use of contraceptives and abortion. They argued on religious grounds that sexuality should only take place within a heterosexual marriage for the purpose of reproduction. In 1970, geneticist Jerôme Lejeune (who had discovered the cause of Down syndrome) shifted the country's antiabortion movement from a religious and moral basis to a scientific one by claiming that life begins at conception because each fertilized egg has its individual set of 23 chromosome pairs. He and his wife collected 10,000 signatures from physicians who opposed the feminist movement's campaign to reform French abortion law. Among French Catholics, comparisons between birth control, abortion, and the crimes of the Shoah had been a recurring theme. The term ‘l’avortement holocauste’ first appeared in 1983 when it was plucked from the translation of American William Brennan's book The Abortion Holocaust: Today‘s Final Solution, which drew a parallel between declaring that a fetus was not a human being and Hitler's 1923 claim that Jews were not humans. ⁵⁰ The American antiabortion movement's ideas and concepts, in other words, circulated transnationally and were readily accepted by antiabortion activists in France.

Much as in France, the Catholic Church in West Germany had related abortion to the Holocaust since 1945 by suggesting that the sexual permissiveness of the Weimar Republic and the moral decay of the Nazi era were to be countered by adherence to strict moral norms. ⁵¹ After the public outcry over the Papal Encyclical Humanae Vitae (1968) revealed that many Germans no longer shared Catholic and conservative views on chastity, child-bearing, and women's gender norms, antiabortion special interest groups began to organize in 1969. ⁵² By the 1980s, the Wilkes’ photographs of aborted fetuses appeared in publications issued by German protest groups. Translations of their brochures could be ordered through grassroots organizations. ⁵³ But in contrast to French and American antiabortion activists, who claimed that an ‘abortion Holocaust’ was already taking place, German clergy and activists perceived abortion as a slippery slope towards a potential second holocaust in the future. ⁵⁴ According to Myra Marx Ferree, the Bishop of Münster's comparison of aborted fetuses to Nazi euthanasia victims in 1974 had sparked such outcry that national media had framed Holocaust comparisons as an insult to politicians who favored legal abortion, women who had abortions and the Nazi victims alike. ⁵⁵ Directly comparing abortion to the Holocaust was a violation of the rules of public discourse in West Germany.

When RU 486 was released in France, the organization La Trêve de Dieu took the lead in fighting against its commercialization, despite its rather marginal position within the French antiabortion movement. ⁵⁶ As the controversy was unfolding in many countries, the network's American partners began to denounce medical abortion as a method ‘to kill unborn children.’ ⁵⁷ Campaigns in the United States claimed that RU 486 would harm American women. Ohio pharmacist Bogomir Kuhar, for example, alleged that Mifepristone caused women to lose six to seven times more blood than surgical abortion and that ‘it causes severe and at times prolonged bleeding in some women up to 42 days after discontinuance of the chemical.’ ⁵⁸ Like the so-called post-abortion syndrome, which suggested that women suffered mentally after a legal abortion, activists used safety concerns about medical abortion as an argument to claim that reversing Roe v. Wade would advance women's safety. ⁵⁹ Biology professor and antiabortion activist Joel Brind took this argument further by claiming that medical abortions exposed American women to the dangers of an HIV infection. Brind alleged that women who had abortions were ‘promiscuous women and prostitutes, the people among whom AIDS is now spreading most rapidly.’ ⁶⁰ If such women suffered prolonged severe bleeding and used a public bathroom, he claimed, they would infect other women using the same bathroom. There is, in fact, no danger of HIV infection from using a public bathroom, but at the height of the AIDS scare, this was a powerful rhetorical figure that distinguished ‘bad’ women, who were promiscuous and had abortions, from ‘good’ American women, whose lives were being endangered by a foreign drug.

In February 1989, an article published in the New York Times offered activists a chance to shift the debate towards morality and the evils of fascism. The article covered the medical abortion controversy in France and pointed out that it was the German Hoechst AG that had halted distribution of the abortion pill. Executives, the article wrote, ‘were dismayed by the right-to-lifers' taunts that Hoechst AG and Roussel were doing to fetuses what the Nazis had done to the Jews. IG Farben, Hoechst's ancestor company,’ the Times explained, had ‘manufactured cyanide gas for the death camps.’ ⁶¹ In fact, Degesch, a subsidiary of IG Farben, had manufactured Zyklon B as a pesticide, but SS officers had used it to kill Jews in Auschwitz with the knowledge of IG Farben executives. ⁶² The New York Times speculated that Wolfgang Hilger, the CEO of Hoechst AG, and a devout Catholic, had personally mandated that the pill's distribution be stopped because he took a conservative position in the West German abortion debate. ⁶³

The fact that Hoechst AG was the legal successor of IG Farben, whose name was associated with Zyklon B and medical experiments on concentration camp inmates during the Nazi era, was a public relations disaster for the company. ⁶⁴ Right when Mifepristone was first released in 1988, publications by medical and economic historians as well as trials for compensation of sterilization abuse victims had made the German public aware of the significant involvement of medical professionals and entrepreneurs in the National Socialist racial state. Peter Hayes’ 1987, Industry and Ideology: IG Farben in the Nazi Era was the first historical monograph to address the role of IG Farben in National Socialism. The book followed Gisela Bock's groundbreaking work on forced sterilizations during the Nazi era, which had been published the previous year. ⁶⁵

Much like Hoechst AG executives had anticipated, when the link between IG Farben and Roussel Uclaf became known in February 1989, antiabortion activists began to exploit it. A resolution by the National Right to Life Committee referred to RU 486 as a ‘human pesticide’ and compared it to Zyklon B, claiming that it had no other function ‘except that of killing a developing baby in the womb.’ ⁶⁶ In a roundtable discussion in July 1989, Jack Wilke reminded audiences that IG Farben was the company ‘that developed the chemical … which was used in the showers that killed the Jews. … The analogy holds true … That was chemical warfare against an entire race and this is chemical warfare against an entire age.’ ⁶⁷ Soon after, activists published the addresses of the Hoechst AG and Roussel Uclaf headquarters in Frankfurt, Paris, and Bridgewater, New Jersey. Grassroots activists sent postcards of gruesome images, displaying the crematoria of Auschwitz with the names Roussel, Hoechst AG, and RU 486 written on the ovens. ⁶⁸ Others showed swastikas with Roussel's and Hoechst's names, cans of Zyklon B, or the entrance to Buchenwald concentration camp. West German pharmaceutical executives must have felt extremely uncomfortable with the association implied in such images. In response, Hoechst AG published a statement announcing that the company would release Mifepristone only in countries where abortion was legal, prostaglandin was available to be used with Mifepristone, and public opinion was in favor of abortion. Hoechst AG decided that distribution in the United States would not be possible because the country did not meet the last two conditions. ⁶⁹

Although protests were global in form, the demands of the National Right to Life Committee focused on the United States. Joel Brind explained in the journal Life Advocate that the antiabortion movement's goal was to keep RU 486 out of the country. ‘If any of these drugs [RU 486 and other abortifacients that European pharmaceutical companies were allegedly working on – C.R.] makes it to the American market, so that it can be prescribed by any doctor,’ he explained, ‘“Pandora's Box” will have sprung open’. Brind argued that even if the American Food and Drug Administration (FDA) approved RU 486 for medical purposes other than abortion, the agency would not be able to control the drug's circulation so that its approval would create a black market for abortion pills. ⁷⁰

In making their case against RU 486, protesters drew inspiration from campaigns in the United States against prostaglandin, the steroid-like compound that was initially combined with Mifepristone. The drug had been designed to induce labor in a full-term pregnancy, but since 1969 physicians in Sweden had conducted trials using it to induce first-term abortions. ⁷¹ In 1975, the National Right to Life Committee threatened a boycott against the American pharmaceutical company Upjohn, which licensed a synthesized version of prostaglandin. This was enough to stop its distribution in the United States. ⁷² Motivated by their success, Wilke and his followers threatened a boycott against all products by Roussel Uclaf, Hoechst AG, and their American affiliate Hoechst Roussel. They also threatened to reveal Hoechst's business interests in Apartheid South Africa in the context of the divestment movement. Wilke even suggested a boycott against all French products, ranging from Michelin tires to Perrier water. ⁷³ According to contemporary sources, the pharmaceutical executives took the boycott threats seriously, as well as death threats against members of their families. Charo and Hanna quote a report in the New York Times that claimed Hoechst AG had business interests of $6 billion annually in the United States. In fact, French Health Minister Claude Évin claimed in his 2006 memoir that Roussel Uclaf's vice president Pierre Joly had revealed to him in a private interview in October 1988 that Hoechst AG halted RU 486's production because it was concerned about its effects on the marketability of the company's other drugs in the United States. ⁷⁴

Although the American protesters’ aims remained strictly national and focused on the United States, they acted transnationally in pursuing them. They received information from their French counterparts and utilized financial and moral arguments to stop European companies from distributing an abortifacient drug. By threatening to boycott French products, activists sought to exert market pressure on the French government. By exploiting the German discomfort with the country's Nazi past, they sought to put pressure on Hoechst AG. Their medical arguments were limited to their exploitation of the HIV-scare and of unsubstantiated claims that fetuses could survive medical abortion and suffer birth defects. In fact, this was a serious concern for Mifespristone's producers, who feared that it could cause birth defects similar to those caused by thalidomide, a drug that causes fetal deformation when taken during pregnancy. After thalidomide scandal in the early 1960s, ⁷⁵ public outcries over serious side-effects of oral contraceptives in 1970, and concerns over faulty IUDs a few years later, pharmaceutical executives dreaded another scandal and costly lawsuits. ⁷⁶ According to Charo and Hanna, their concerns led American pharmaceutical entrepreneurs to stop their companies’ contraceptive research in the early 1980s. ⁷⁷

Due to such hesitancy within the industry and the support of conservative governments, the antiabortion movement's strategy initially was successful in Germany and on the American home front. Although President Ronald Reagan's antiabortion stance had been symbolic rather than effective, the FDA under his successor George H. W. Bush imposed an import ban on RU 486, which prevented researchers in the United States from conducting clinical trials necessary for market approval. ⁷⁸ A congressional directive banned funding from the National Institutes of Health (NIH) for contraceptive and abortion research, and this ban included the use of RU 486 as an abortifacient. ⁷⁹

In response to the globalized antiabortion militancy, therefore, supporters of medical abortion formed a coalition consisting of scientists (who felt that import and research bans stifled research), family-planning campaigners, abortion rights activists, and feminists in Europe, Canada, and the United States. ⁸⁰ According to historian Heather Munro Prescott, Marie Bass of the National Abortion Rights Action League (NARAL) had learned about medical trials for RU 486 as early as 1987, before the National Right to Life Committee had campaigned against it. She formed a coalition of family-planning associations, population control interest groups, abortion-rights activists, public health officials, the women’s health movement, and Latina and Black feminists in support of medical abortion. As mentioned earlier, the latter joined the coalition even though they remained skeptical of the new invention. Women's health activists and feminists of color voiced their concern that medical abortion had not been sufficiently tested, especially its efficacy for poor women suffering from either malnutrition or obesity. Based on the historical experience of oral contraceptive trials in Puerto Rico, the side effects of long-lasting contraceptives, and coercive sterilization, they worried that women of color could once again become guinea pigs of an unproven method of fertility control. Meanwhile, the Feminist International Network of Resistance to Reproductive and Genetic Engineering (FINRRAGE) was especially concerned about the combination of RU 486 with prostaglandin. According to Clarke and Montini, such varied responses by different feminist groups illustrate ‘multiple perspectives’ on the new reproductive technology. ⁸¹

The West German family-planning organization Pro Familia and its French counterpart MFPF were the driving forces behind the local introduction of medical abortion. ⁸² Both were members of the International Planned Parenthood Federation (IPPF), which had collaborated with the WHO on various projects and had followed the development of medical abortion since the 1960s. The French MFPF took part in the abovementioned stage 3 clinical trials for Mifepristone and was instrumental in producing guidelines on how to administer the drug in clinical settings. In reunited Germany, Pro Familia organized two international conferences on medical abortion in 1990 and 1992. Family-planning organizations and feminists from both France and the United States, along with their Canadian and British colleagues, attended the 1993 conference and drafted a petition to Hoechst AG to demand the distribution of RU 486 ‘in those countries in which abortion is lawful.’ ⁸³

European family-planning campaigners made use of a well-established transnational women's health network. The women's health movement, which was distinct from both the mainline feminist and the consumer rights movements, had come into being when feminists in various cities in the United States and West Germany had started to write self-help manuals, investigate the side effects of the pill, and teach self-examination in the early 1970s. ⁸⁴ California feminist Carole Downer, who was one of the founding members of the American women's health movement, had established a transnational network when she first visited the Feminist Women's Health Center in Berlin in 1973. In 1989, she was among the German and American women's health representatives who visited a family-planning clinic in Paris to circulate information on the progress of RU 486 in their home countries. ⁸⁵ German and American visitors interviewed patients on why they had chosen medical over surgical abortion. ⁸⁶ According to East German activist Lykke Aresin, ‘most women chose the RU 486 method because it did not necessitate a surgical intervention and gave them the feeling of being actively involved in what was happening.’ ⁸⁷ Other patients said that they preferred surgical abortion with general anesthesia as it was over quicker and easier to be done with. Abortion rights activists felt encouraged to pursue their goal of making Mifepristone available to give women a choice of abortion methods. ⁸⁸

Although European and Canadian feminists demanded that Hoechst AG distribute Mifepristone in all countries where abortion was legal, the Feminist Majority Coalition, a Washington-based lobby organization directed by former NOW president Eleanor Smeal, used the slogan ‘Don't let them keep it away from American women’ in its fundraising campaigns. ⁸⁹ The organization's 1990 petition avoided the term abortion pill and called Mifepristone a ‘new simple method of fertility control’ and a new way to ‘non-surgically terminate unwanted pregnancies.’ ⁹⁰ In addition, it highlighted the nonreproductive use of RU 486, hailing it as a breast cancer ‘cure’ and demanding its distribution in the United States as a treatment for ‘ailments affecting both men and women.’ ⁹¹ A resolution passed by the National Organization for Women (NOW) at its 1990 conference presented reasons that RU 486 could benefit public health beyond abortion:

[It is] an effective, safe agent for fertility control, especially for the medical termination of early pregnancy and as a menses inducer; [it] is a potential treatment for breast cancer (which affects one of every ten American women), endometriosis (which is one of the major causes of infertility in women), glaucoma, prostate cancer and other medical conditions, and a proven treatment for Cushing's Syndrome, and which may be effective in inducing labor in a difficult delivery, thereby reducing the number of Caesarian sections and the risk to women and their babies. ⁹²

By using euphemisms, highlighting alternative uses of the drug, stretching its positive effects, and avoiding the term abortion, the Feminist Majority Coalition refuted the antiabortion movement's claim that Mifepristone's only function was to end a pregnancy and that it would hurt American women. According to historian Michelle Murphy, the feminist organization had undergone a process of professionalization and was trying to convey a less controversial message in order to attract donations from wealthy but socially conservative donors. ⁹³ It used tactics similar to those of the antiabortion movement by stretching the claims of science. The organization took a defensive position when it veiled the drug's emancipatory effects for reproductive justice.

In pursuit of their quest to make RU 486 available in the United States, the representatives of the Feminist Majority Coalition traveled to Paris and Frankfurt to negotiate with executives directly. Rather than relying on grassroots mobilization or directly engaging with the comparison of medical abortion to the Holocaust, they responded to the economic aspect of antiabortion protests. Presenting the signatures of 115,000 petitioners and 250 doctors, their message was that Roussel-Uclaf and Hoechst AG had ‘more to fear from a boycott from the overwhelming majority of Americans who want abortion legal.’ ⁹⁴ Their main demand was that Hoechst AG gives the patent to another company willing to distribute it or that the company found a nonprofit pharmaceutical producer immune to boycott threats. Activists were convinced that concerns over profits (rather than moral considerations) underlay Hoechst's hesitation to release Mifepristone.

The feminist coalition also suggested producing a generic version of RU 486 in an American laboratory. They demanded that US states allow patients to take Mifepristone without FDA approval, similar to exceptions made in California for AIDS medication. ⁹⁵ When President Bill Clinton took office in January 1993, he showed his support for abortion rights by issuing executive orders to lift the ban on NIH research and on the import of RU 486. Soon medical trials in preparation for FDA approval began in Portland, Oregon, and in Rockville, Maryland. ⁹⁶

But the Clinton administration's support made Roussel Uclaf and the French Republic targets of transnational antiabortion activists again. On 21 June 1993, the day of a meeting to Roussel Uclaf's executive board, a French antiabortion group staged a protest in front of the Paris headquarters of Roussel Uclaf. On the same day, several hundred antiabortion protesters picketed French institutions in the United States and seven other countries. American antiabortion activist Paul de Parrie, who had coordinated the protests, reported from the French capital that picketers held up signs reading: ‘ROUSSEL-HOECHST tue les bebes [sic]’ (ROUSSEL-HOECHST kills babies) – the double ‘s' in Roussel was written in the lightning bolt fashion as with the Nazi SS symbol.’ Other picket signs displayed cardboard versions of American president Bill Clinton with swastika eyes. ⁹⁷

Reunited Germany was surprisingly absent from their protest map, even though activists here easily mobilized 15,000 people to protest against reform of abortion legislation. ⁹⁸ By 1990, there were a few freestanding abortion clinics in northwestern Germany and individual arson attacks had taken place, but militant protest strategies like those of Operation Rescue never took a foothold in the West German movement. ⁹⁹ Displaying swastikas and SS runes in public was neither legal nor socially acceptable for the majority of Germans in the early 1990s. According to cultural anthropologist Michi Knecht, the antiabortion movement had lost its moral high ground when it endorsed anti-Semitic positions by claiming that there was a conspiracy between Jewish billionaires, environmentalists, and population control advocates to plan systematic mass murder. ¹⁰⁰ In contrast to France and the United States, the federal government under Helmut Kohl was in favor of restricting abortion access, and local politicians were successful in blocking legal change on the federal level. The same year that protesters picketed French institutions around the globe, the German Constitutional Court ruled in favor of the Bavarian Christian Socialist Party (CSU) that the abortion compromise established after reunification was unconstitutional. As a result, German lawmakers found a solution for uniting West German and East German legislation by declaring abortion illegal but exempt from punishment under certain circumstances. ¹⁰¹

In the reunified Germany, the 1993 abortion reform compromise put an end to antiabortion protests. In May 1994, one month after Hoechst CEO Wolfgang Hilger retired, the company transferred the American patent rights of RU 486 to the Population Council. It was not very surprising that Hoechst AG chose the council rather than another organization even though feminists had dismissed it as part of a ‘population control establishment’ trying to lower global population growth by imposing long-lasting contraceptives on minority women. ¹⁰² But the Population Council was also a large and financially secure NGO that had gained experience in licensing contraceptives and HIV medication in the Global South. It had also previously sponsored research into medical abortion and supported the RU 486 medical trials at the University of Southern California. ¹⁰³ The Population Council then began to distribute Mifepristone in the United States through a single-product company immune to boycott threats. In 1997, when Hoechst AG bought the remaining shares of Roussel Uclaf, the company found a similar solution for distributing the drug in Europe. Mifepristone became available in Germany in 1999 and in the United States in 2000, long after it had been introduced in France, China, Britain, and Sweden. ¹⁰⁴

The controversy surrounding the abortion pill highlights the intersection of biomedicine with historical debates in the 1980s and 1990s, which makes it relevant for both medical and contemporary historians alike. Moral and economic considerations based in the German discomfort with its own past rather than medical concerns delayed the approval and distribution of Mifepristone globally. A vocal antiabortion movement tried to block distribution. It acted out of a moral conviction that abortion was murder, and it pursued blunt strategies that sought to depict pharmaceutical executives as Nazi war criminals. Although it is unclear whether it was Hoechst CEO Wolfgang Hilger's moral conviction or his concern for profits that impeded the distribution of RU 486, his decision suggests that antiabortion activists hit a nerve when they drew comparisons between medical abortion and the Holocaust.

Referencing the Holocaust in abortion debates was a strong rhetorical tool because it evoked stark emotional reactions internationally and was especially effective when it was related to particular national narratives. US-American activists could derive their call to antiabortion militancy from a narrative of moral superiority that called for a global fight against Nazism. French clerics could invoke a narrative of fetal victimhood and resistance to an ambivalent modernity. West German Catholics and pharmaceutical executives blocked medical innovation with an attitude of ‘never again’ by distancing themselves from their company's and country's Nazi past. The success of the abortion movement was that it found a form of protest that resonated with the cultural opportunity structures of the three major nation-states involved in the production of RU 486.

Meanwhile, abortion rights campaigners focused on the economic side of the controversy by seeking possible solutions to the boycott threats. Instead of relying on grassroots mobilization, the feminist movement chose to negotiate directly with pharmaceutical executives and nongovernmental representatives. Like the antiabortion protesters, they used international networks to stage protests and petitions, while at the same time they relied on local alliances with politicians and executives. This shows that supporters of medical abortion relied on local political opportunity structures to reach their goals. It also reveals that protests were local and country-specific even if the goals of the pro-choice coalition were transnational.

Through their boycott threats and Holocaust imagery, antiabortion activists managed to delay further medical research for several years. This shows that biomedical advances, to be successful, depended on significant nonmedical variables. Surprisingly, these variables not only included patient advocacy groups demanding broader access to medication and feminists of color highlighting the dangers of technology abuse. They also had to consider the discomforts of a nation coming to terms with its own past. The medical abortion controversy was multifaceted, not only because it involved multiple special interest groups, but because it drew on academic advances in sciences and humanities alike. And this had a real-life impact as it delayed the market introduction of an innovative drug that had the potential to save thousands of women's lives.