This afternoon gynecologist Gunilla Kleiverda has a discussion in Almelo, tomorrow in Leeuwarden, and later she goes to Alkmaar. She is seventy and could have enjoyed her pension carefree, but these days she travels past doctors and hospitals throughout the Netherlands to set up the largest study ever to a hormone contraceptive pill: Mifepriston. She already got thirteen hospitals to participate. Ultimately, twelve hundred women will participate in the study.
The new plea, which blocks the functioning of the pregnancy hormone progesterone, offers a solution for the growing group of women who do not want or cannot use the contraceptives with hormones, for example due to an increased risk of thrombosis or hereditary breast cancer, or because of the influence on their mental well -being.
“Breaking: After 60 years there is a new contraceptive pill without hormones, “headed a big magazine after the investigation was announced this spring.” I can cry, “says an enthusiastic influencer on Tiktok, in one of the many viral films on this subject. The exhausted response gives the impression that this medicine only came on the radar of science when contraception has come, but the opposite is true, Gunilla Kleiverda also knows.
The money for the investigation is brought together – including through crowdfunding – by women’s rights organization Women on Waves, of which Kleiverda is chairman – in 2001 she took on the first journey of the ‘abortion boat’ by Women on Waves, intended to make abortion accessible to women in countries where it is not allowed.
“Normally this type of investigation is done by the pharmaceutical industry, with a lot of money,” says Kleiverda. “But they didn’t want to pay for this study.” Because there is little to be earned, she thinks. “The patent on Mifepriston has been going on for a long time.” She also suspects that the “sensitivity” of the drug plays a role. Mifepriston has been used for years for drug abortions, it is (in addition to misoprostol) one of the two drugs that are known together as ‘the abortus pill’.
Kleiverda receives NRC At the kitchen table of her Amsterdam home. Next to her laptop are books on women’s health, self -determination and feminism. On top of a book by Étienne-Émile Baulieu, the recently deceased biochemist and endocrinologist who discovered Mifepriston in 1980. At that time, the first small -scale investigations into the drug were done – which showed that it could be a good contraceptive with few side effects.
Only so much later did you believe that Mifepriston should come on the market as a contraceptive?
“To be honest, I did not like that idea for a long time, not even after the appearance, in 2007, of a relatively large Chinese study with promising results. We did not on this study until 2013, when a scientific interns of Women on Waves pointed out to us.”
Mifepriston within reach on the bedside table is a logical next step for me
Earlier the time was not ripe for it, Kleiverda thinks. The emancipation struggle took place for a long time on other fronts, such as reimbursement of the pill from the basic health insurance. In 1964 the (hormonal) pill in the Netherlands was welcomed as a revolutionary, which left little room for a conversation about side effects and alternatives in the decades.
Furthermore, women’s rights had activists Long their hands full of abortion. The Abortion Act was eventually introduced in 1984, so that women could legally break down their pregnancy – albeit only in special clinics. Initially, women there received suction treatments (curettages); Around the change of millennium, drug treatment with mifepriston and misoprostol became possible. Only since this year is this abortion medication (‘the abortion pill’) not only available from general practitioners in addition to the eighteen abortion clinics.
How did the cover in your thinking about Mifepriston go?
“It was a logical consequence of the development that we went through at Women on Waves. In 2001 we wanted to give curetta treatments on a boat off the Irish coast, but we also had abortion medication on board. That was only just available on the Dutch market, only in an abortion clinic or at a gynecologist.” Abortion through medication was easier than with suction treatment, because you could give the medicine home.
“During a trip to Portugal in 2004 I came to the insight that abortion could become even more accessible. Two warships hinded us access to national waters. We were so angry that Rebecca [Gomperts, oprichter van Women on Waves, red.] On the Portuguese housewives TV has explained how you can do an abortion at home with Misoprostol, which is also in some painkillers and generates contractions in high dosage. They could buy that at the pharmacy without a prescription. Abortion without the intervention of doctors and souls.
“Not long after, we founded Women on Web. Via that route, women all over the world needed for an abortion could be delivered to your home after online consultation. Mifepriston as a contraception, within reach on the bedside table, is a logical next step for me.”
Almost twenty -five years after that first boat trip, Kleiverda leads a study that unites the three things for which she has fought her entire career: self -determination of women, good contraception and accessible abortion. Because the research into Mifepriston as a hormone -free contraceptive pill has a double agenda, Kleiverda is honest about that when asked. “With Mifepriston, the gap between contraception and abortion can also be closed.” Abortion and contraception are in each other’s extended, says Kleiverda. “Ultimately, both are care of women who don’t want to be pregnant. They want a good medicine for that.”
Do you think it is important from an emancipatory point of view that this contraceptive is available for women?
‘The stamp’ Abortus Pil ‘suggests that there is a pregnancy that is being demolished. But from when are you pregnant? Is that immediately after fertilization, after a positive pregnancy test, after the first menstrual period, after the implantation of the fertilized egg in the womb tests before you are moving forward. Staying out already gives a positive result.
“In the Netherlands there has been an unrest about the rising number of abortions in recent years, but if we look at the numbers better, we see a growing group of women who are already reporting for a termination of pregnancy before the first menstrual period has failed. They are not even over time, but they do not want to be pregnant and have a medicine against it. Now we mentioned abortus; these women had had it.”
Kleiverda lays a hand on the stack of books next to him. “Baulieu, the inventor of Mifepriston, for that reason came up with a much more appropriate term for this medicine, he called it the”Un-pregnancepilland speaks of counterestion – The gang of pregnancy, before or after sex. Mifepriston does exactly that. It works as a front and excess and therefore also as a morning-after pill. You can already buy the current MorningaFterpil, Ulipristal or Ella-One, a sister of Mifepriston at the drugstore. We must completely get rid of that distinction between contraception and abortion. Call it: take care of women who do not want to be pregnant. This pill brings all that together. “
You don’t ask someone who asks for breast reductions if she has thought about breast augmentation
Suppose that pill will be a success, then women may have large amounts of Mifepriston on their bedside table. That is what subsidy provider ZonMw is ‘dangerous’, which is why that organization has decided not to subsidize your investigation.
“The medical-ethical assessment committee thinks our research is justified, but ZonMw said indeed: Mifepriston is a means that arises abortion; with repeated prescribing for contraception, there is a risk of saving and illegal resale for abortion. That is a non-argument. Saving and resale can be done in 2007. Drugstore.
What still needs to happen before the drug can come on the market?
“After the European Medicine Agency has approved the plea – presumably in three to five years – the Nederland Zorgstituut will have to consider whether it will also be reimbursed as a contraceptive pill.”
Can politics still thwart?
“Politicians have no leg to get up. It is of great importance that we see Mifepriston as a normal drug, with different applications. In the United States, it is registered in high dose for the treatment of Cushing’s disease; in the Netherlands it is used on a large scale and now even reimbursed for the treatment of miscarriages and there is a drug for treatment for the treatment of treatment. Mifepriston as a hormone -free contraceptive. The association with abortion must be released. ”
You have seen the right to self -determination of women increase during your working life, but now a conservative wind is blowing again. How do you look at that?
“The Netherlands seems progressive. Yet Abortion is still in the Criminal Code here. Therefore, with a request for abortion, doctors are legally obliged to ask the woman whether she does not want to continue the pregnancy. And: whether she has considered adoption, or foster care. Van de Zotte! Unethical.
“I see a new generation of women who are very actively committed to this.” Laughing: “The Dolle Mina’s have stood up again. And with astonishment I look at the ‘Tradwives’, women who wish themselves and other women back to the counter. There is still much to do.”