In countries where women have little or no access to a safe abortion, a tiny hexagon-shaped pill developed for ulcers is revolutionizing women’s lives, allowing them to terminate their pregnancy more safely.
But in Haiti, where clandestine abortions are leading to a public health crisis, that same pill is having potentially dangerous consequences as women give themselves an at-home abortion as easily as a pregnancy test.
Proponents of misoprostol, which is sold in Haiti under the brand name Cytotec, say it could be a stop-gap measure for unsafe abortions, but that women in Haiti need to be counseled on its proper use. While the country’s unregulated prescription drug environment allows easy access to misoprostol, fear of criminal prosecution because of the abortion ban often prevents women and girls from seeking medical help when complications arise.
“There is no control over the medication. People go to any pharmacy and ask for this medication and they give it to them,” said Dr. Vladimir Larsen, head of the Society of Haitian Obstetrics and Gynecology , which has conducted two studies in the last four years on the widespread popularity and use of misoprostol.
When Nadia, 19, asked a friend to purchase misoprostol at a local pharmacy to terminate her five-week pregnancy, she wasn’t prepared for how her body would react. The friend bought three pills and told her “they said take two and insert the third.”
“You hear people talk. But you don’t realize where it can have you end up,” Nadia said from her hospital bed after an incomplete abortion. Two days after secretly downing two pills, the teen landed at the emergency obstetrics center run by Médecins Sans Frontières/Doctors Without Borders in the city of Delmas in Haiti’s capital. She had shivers, heavy bleeding, a fever and a headache.
“My stomach burned like there was gas inside,” she said.
Catrin Schulte-Hillen, a reproductive health advisor with MSF in Geneva, Switzerland, said while some of the side effects experienced by Nadia are common, issuing the drug without counseling women, risks life-threatening complications. MSF plans to address the issue in a book on women’s health to be published next summer. Chapters will be first rolled out online starting on International Women’s Day on March 8.
“It’s perfectly safe when taken in the adequate amount,” Schulte-Hillen said. “Misoprostol is not the problem. The problem that we have is in a place like Haiti, the woman doesn’t get adequate information and in the absence of a medical consultation, contraindications for the use of the drug are ignored.
“Either she takes too little, starts bleeding and the fetus doesn’t get expulsed or she takes too much and she has a high fever,” she added. “She has terrible cramping and severe bleeding, which may be the result of taking too much. We’ve seen both in Haiti.”
A Miami Herald reporter easily purchased the pill from pharmacies, and street merchants near the country’s public State University Hospital. Every vendor quoted a different price and instructions on how much to take to terminate a 12-week pregnancy. Almost all suggested it be taken as part of a cocktail mix of wine or beer, as they dug deep into colorful cone-shaped buckets to retrieve the pill from a silver package. They simply smiled when asked why it was hidden.
Amanda Klasing, women’s rights researcher for Human Rights Watch, said Haiti’s health ministry “cannot ensure the safety of Haitian women and girls when misoprostol is widely available on the market, but illegal.”
Nor can it guarantee the quality of the drug, said Flaurine Jean-Jeune Joseph, the head of the ministry’s controlled drug unit. Joseph acknowledged Haiti’s unregulated pharmaceutical environment is a problem and said efforts are under way to tighten controls over all medication sales.
Misoprostol, Joseph said, had been banned until 2009 when it was allowed at the request of gynecologists who use very small amounts to help with difficult deliveries. She later said that a Cytotec brand the Herald purchased from vendors near the main public hospital in Port-au-Prince was not on the ministry’s approved list.
A 2009 study by SHOG, the gynecology group, warned that failed abortions using the pill could lead to deformities in babies. The World Health Organization has also warned about worldwide abuse of the pill, saying it could lead to incomplete abortions or other complications.