In Brazil, a nation where abortion is illegal, hundreds of thousands of pregnant women have induced abortions by taking a drug intended to treat stomach ulcers, two new studies report. The studies, which appear in the current issue of The Lancet, a medical journal published in Britain, shed new light on the shadowy world of abortion in Brazil, Latin America's most populous nation.
Studies in Family Planning Jul-Aug 1993;24(4):236-40.
The Brazilian experience with Cytotec
R M Barbosa, M Arilha
Cytotec, the commercial name for misoprostol, which is a synthetic analogue of prostaglandin E1, was approved for use in Brazil in 1986 to treat gastric and duodenal ulcers. The drug can and has also been used to induce abortion, which has created controversy in a country in which induced abortion is illegal. A study of the drug was undertaken in 1992 that included analyses of the drug's sales profile, of information published by the media, and of its use from women's and gynecologists' points of view, the latter examined using qualitative methodologies. The analysis of Cytotec's sales volume showed quick growth from its introduction until the first half of 1991, when its use was restricted by the Ministry of Health. For women, Cytotec's main advantages have been that it is relatively inexpensive, convenient to use, and can be used in private. Data obtained from gynecologists show that Cytotec's addition to the obstetric therapeutic arsenal was welcome and also confirmed the drug's influence in reducing the complications of illegal abortions shown in other studies.
PIP: A Brazilian study of 1986-92 sales of the prostaglandin analogue, misoprostol (Cytotec), often used as an abortifacient in Brazil, shows that an increasing trend began in January 1989 and was maintained until July 1991, when the Ministry of Health (MOH) imposed restrictions on Cytotec sales. Cytotec introduced in mid-1986 as a treatment for gastric and duodenal ulcers. Sales reached their lowest levels in 1992 (150,207 vs. 189,199-581,003 annual sales). Other factors contributing to the fall in sales wee reduced production due to an agreement between the manufacturer and MOH, a newspaper campaign by anti-Cytotec groups, and a law for a double-copy prescription. Hospital surveys in the early 1990s indicated that many women used Cytotec to induce an abortion. The media, pharmacies, physicians, women, and the manufacturer spread the news that Cytotec could be used to induce abortion. Women take 4-16 doses of Cytotec to induce abortion, generally during the first trimester. The use Cytotec because it is relatively inexpensive and less traumatic than other abortion methods and can be taken in privacy. Women also consider Cytotec to be safe. Nevertheless, most women complain of the pain they experience and the need to eventually go to a hospital. These negative views are a result of lack of information about the physical process of the drug. Gynecologists of the Sao Paulo public health system confirm the widespread use of Cytotec as an abortifacient. Cytotec allows gynecologists to perform abortions without the police being involved since women induce an abortion with Cytotec, and gynecologists perform a curettage. Hospital staff consider this type of induced abortion more acceptable than other methods. It also allows them to avoid the feelings of inadequacy they experience when women are admitted for an infection caused by a botched abortion or perforated uterus. These findings demonstrate that a favorable atmosphere exists in Brazil to promote the legalization of abortion.
K.A. Zikopoulos, E.G. Papanikolaou, S.N. Kalantaridou, G.D. Tsanadis, N.I. Plachouras, N.A. Dalkalitsis, E.A. Paraskevaidis
Human Reproduction, Volume 17, Issue 12, December 2002, Pages 3079–3083, https://doi.org/10.1093/humrep/17.12.3079
Published: 01 December 2002
BACKGROUND: Misoprostol is a prostaglandin E1 analogue that has been used for medical abortion. We conducted this prospective study to compare the efficacy of vaginal misoprostol for abortion in women at a gestational age of <42 days and in women at a gestational age of 42–56 days. METHODS: A total of 160 women seeking medical termination of a pregnancy of <56 days were enrolled in the study. Medical termination was performed using 800 μg of vaginal misoprostol, repeated every 24 h for a maximum of three doses. RESULTS: The overall complete abortion rate was 91.3%. In group A (gestation <42 days) complete abortion occurred in 96.3% of women, whereas in group B (gestation = 42–56 days) complete abortion occurred in 86.3% of women (P < 0.025). The two groups did not differ significantly with respect to side-effects (incidence of pain, bleeding, nausea, diarrhoea, fever and headache). Women who had aborted successfully were significantly more satisfied with the method compared with women who did not (P < 0.001). CONCLUSIONS: The vaginal misoprostol-alone regimen is highly effective for women seeking medical abortion of pregnancies of ≤56 days. However, better efficacy may be achieved at a gestational age of <42 days.
Abortion in Brazil: Legislation, reality and options
Abortion in Brazil: Legislation, reality and options - ScienceDirect
Alessandra Casanova Guedes
https://doi.org/10.1016/S0968-8080(00)90188-5Get rights and content
Abortion is illegal in Brazil except when performed to save the woman's life orin cases of rape. This paper gives a brief history of parliamentary and extra-parliamentary efforts to change abortion-related legislation in Brazil in the past 60 years, the contents of some of the 53 bills that have been tabled in that time, the non-governmental stakeholders involved and the debate itself in recent decades. The authorities in Brazil have never assumed full public responsibility for reproductive health care or family planning, let alone legal abortion; the ambivalence of the medical profession is an important obstacle. Most politicians avoid getting involved in the abortion debate, but the majority ofbills in the 1990s have favoured less restrictive legislation. Incremental legislative and health service changes could help to improve the situation for women. Advocacy is probably the most important action, to promote an environment conducive to change. Clandestine abortion is a serious public health problem in Brazil, and the inadequacy of family planning services is one of the causes of this problem. The solutions should be made a priority for the Brazilian public health system.
Unsafe abortion: the preventable pandemic*David A Grimes, Janie Benson, Susheela Singh, Mariana Romero, Bela Ganatra, Friday E Okonofua, Iqbal H Shah
Ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights imperative. As with other more visible global-health issues, this scourge threatens women throughout the developing world. Every year, about 19–20 million abortions are done by individuals without the requisite skills, or in environments below minimum medical standards, or both. Nearly all unsafe abortions (97%) are in developing countries. An estimated 68 000 women die as a result, and millions more have complications, many permanent. Important causes of death include haemorrhage, infection, and poisoning. Legalisation of abortion on request is a necessary but insufficient step toward improving women’s health; in some countries, such as India, where abortion has been legal for decades, access to competent care remains restricted because of other barriers. Access to safe abortion improves women’s health, and vice versa, as documented in Romania during the regime of President Nicolae Ceausescu. The availability of modern contraception can reduce but never eliminate the need for abortion. Direct costs of treating abortion complications burden impoverished health care systems, and indirect costs also drain struggling economies. The development of manual vacuum aspiration to empty the uterus, and the use of misoprostol, an oxytocic agent, have improved the care of women. Access to safe, legal abortion is a fundamental right of women, irrespective of where they live. The underlying causes of morbidity and mortality from unsafe abortion today are not blood loss and infection but, rather, apathy and disdain toward women.