Abortion pill, a dose of danger
A drug meant for the treatment of ulcers has now become the tool of choice for young women seeking abortion, writes ARTHUR OKWEMBAYoung college and high school girls are increasingly turning to an ulcer treating drug — Misoprostol, readily available in local pharmacies—for abortion, but doctors now warn this could lead to serious health complications.
Misoprostol going by the trade name Cytotec, which is not for use by pregnant women, has been a topic of debate in the developed countries for some time now. An article in the International Journal of Gynecology and Obstetrics, two years ago, warned against using Misoprostol alone for abortion purposes.
Several studies have shown that an 800-microgram dose of Misoprostol, about four pills, is 60 per cent to 90 per cent effective at ending a pregnancy when taken alone in the first seven weeks.
In the US it has been used legally for years in regimen that includes the abortion pill mifepristone, popularly known as RU-486.
A spot check at city chemists by Horizons, established an increasing demand of the drug mainly by young women without prescription notes.
“We have had to turn away several women for lack of prescription notes from physicians,” says Simon Siele, an attendant at a city pharmacy.
Siele recalls how one woman pleaded for the drug claiming to be HIV positive and not wanting to carry the pregnancy to term. “But we still declined to sell her the medication.”
But women have become smart, and are able to get prescription notes from unethical doctors; a thing pharmacists say can do nothing about.
“Once a client presents a prescription note, its not our business to determine authenticity but to comply,” says an attendant at another pharmacy on Moi Avenue, Nairobi.
Misoprostol is indicated by the manufacturers to be for prevention and treatment of gastric ulcers and excessive acid production only.
It treats people who have developed ulcers after long-term use of painkillers, until in recent years when women and some scientists realised it could also be used for other purposes.
The dosage required to induce an abortion goes for less than Sh1,000, a fraction of what they would spend in seeking backstreet operations.
Most of the gynecologists we talked to did not want their identities revealed for fear of being thought to be sympathetic to illegal abortions.
But they readily admitted that women are using the drug even when totally unaware of possible side effects, incase of misuse.
“I have attended to three cases of incomplete abortion, mainly caused by wrong dosage and poor timing,” said a doctor who operates a clinic on Tom Mboya Street, Nairobi.
Gynecologists caution that if the drug is not administered by qualified medical personnel, the woman may not be able to identify an incomplete abortion incase it so happens.
These women will only realise something is wrong once they start experiencing excessive bleeding, uterine perforation, aneamia, or pelvic inflammatory disease.
Overdosing, when the pregnancy is over four months old, will result in excessive contraction and rupture of the uterus. In this case, the only option is uterus removal, an action that makes it impossible for such women to give birth ever again.
Women who unsuccessfully use the drug for abortion end up with deformed babies according to the International Journal of Gynecology and Obstetrics.
“Caution is recommended when administering Misoprostol for abortions beyond nine weeks. There is insufficient evidence to recommend a regimen of Misoprostol for late first trimester abortion induction,” the journal warns.
Currently in Kenya, abortion cases are said to have doubled from 400 to 800 a day in just under 10 years. According to the World Health Organisation, 4.2 million unsafe abortions occur in Africa every year, resulting in about 30,000 deaths. Majority of these deaths are due to excessive bleeding, anemia and other infections.
The scientific community first realised Misoprostol’s properties to procure abortion when they learnt it could cause miscarriage when used to treat ulcers in pregnant women. This was further strengthened when doctors started using the pills to clear incomplete abortions.
It is also believed that the warning by its manufacturer, not to be used by pregnant women for it is likely to induce a miscarriage, was a pointer to this an intended use.
Despite the manufacturers warning, researchers have gone ahead to study the ability of the drug to manage many reproductive health issues related to women.
A nurse at Kenyatta National Hospital said clinical studies are underway at the institution to establish the safety and effectiveness of the drug when used to induce labour pains in women with prolonged pregnancies.
Proponents of abortion want the pharmaceutical industry to manufacture and register the drug as a medical intervention for women’s reproductive health problems such as inducing labour pains. But this has been vigorously opposed in many African countries, with abortion legally allowed only in certain circumstances.
In Cameroon, Kenya, Sierra Leone, Central Africa Republic, Botswana, Burkina Faso, Caper Verde, Togo, Ethiopia, Zambia, Zimbabwe, and Senegal, just to mention a few, abortion is allowed if it is to save the mothers life. In Sierra Leone and Cameroon, it is permitted if the pregnancy is a result of rape.
While in Togo it is legalised, with a doctor’s approval, in cases of rape and incest. Other countries permit abortion in cases of foetus deformation or if the pregnant woman is mentally handicapped
Only in South Africa is an abortion allowed on demand since 1997. In Ethiopia, abortion is legal on demand for 18 year-olds and below.
Much of the pressure being exerted on the pharmaceutical companies follows a raft of research information, which has shown the ulcer drug to be a useful tool for abortion.
According to a study published in the 2005 The New England Journal of Medicine, the drug was used successfully in women who had experienced pregnancy failures — foetal death or incomplete spontaneous abortions. Of the 491 women who were given Misoprostol, 71 per cent had complete expulsions of the foetus.
Says the Journal: “Misoprostol therapy as an alternative to surgery appears to be highly acceptable where it has been tested. Using it in an outpatient settings reduces cost of services and does not require sterilized equipment or surgically skilled personnel.”
Studies in Uganda have returned similar verdict, although the dosages of Misoprostol used were different.
– An AWC feature
