Misoprostol Is a Game-Changer for Safe Abortion and Maternal Health Care. Why Isn’t it More Widely Available?

 

by Francine Coeytaux, Public Health Institute (PHI)

and Elisa Wells, Independent Consultant

May 28

 

http://rhrealitycheck.org/article/2013/05/28/why-arent-we-taking-advantage-of-the-potentially-game-changing-drug-misoprostol/  

 

Misoprostol: Have you heard about this small, inexpensive, and most importantly available pill that can save women’s lives? Pragmatic Brazilian women first discovered the potential of misoprostol (or Cytoteca, in their parlance) in the 1980s. According to the label on this widely used peptic ulcer drug, it was not to be taken during pregnancy as it could induce bleeding. Living in a country with very restrictive policies and little access to safe abortion services, they recognized the opportunity to circumvent the system and, by word of mouth, spread the word to other women about this easily obtainable pill that could help them safely end an unwanted pregnancy.

 

Thirty years later, women in countries around the world are beginning to do the same-continuing to spread the word, talking to each other about misoprostol, and trying to get their hands on these pills. The women who are accessing the drug in their communities and taking it by themselves have shown us that there are relatively few health risks involved with misoprostol. What began in Brazil as a natural public health experiment has been validated by rigorous clinical studies conducted by international groups such as the World Health Organization and Gynuity. These studies have shown that the use of misoprostol for abortion is very safe, especially when taken early on in the pregnancy; while not as effective as when taken in combination with mifepristone (another abortion pill), misoprostol taken alone will safely terminate 75 to 90 percent of early pregnancies when taken as directed.

 

Misoprostol has also been proven to have numerous other lifesaving properties, including the ability to prevent and treat postpartum hemorrhage and to induce labor. It is registered in more than 85 countries, usually as an anti-ulcer medication, and is used off-label by clinicians around the world for numerous reproductive health indications. In addition to these clinical uses, we are beginning to see positive public health outcomes from community-based use of misoprostol. In countries where abortion is restricted and women are using misoprostol, we have seen a reduction in infections. And in under-served communities, where women delivering at home are taught to take misoprostol immediately after delivery, postpartum hemorrhage is significantly reduced.

 

If we have a cheap and readily available drug that can prevent and treat the two largest causes of maternal mortality worldwide-postpartum hemorrhage and unsafe abortion-why have we not taken more advantage of this exciting technology? Given the global attention being paid to meeting the fifth Millennium Development Goal (MDG 5)-that of reducing maternal mortality-it is difficult to fathom why we continue to squander the opportunity misoprostol offers us.

 

The public introduction of any new technology takes time and is not easy; the introduction of emergency contraception is just one of the latest examples. Reproductive health advocates have been working for decades to increase women’s access to this safe, effective, and non-abortifacient technology. While much progress has been made around the world, the recent action of the Obama administration to prevent full over-the-counter access in the United States is a sad illustration of the hurdles women face in accessing reproductive health technologies. The hurdles we face in introducing misoprostol will be even higher given three inherent characteristics:

It has multiple indications, including abortion.

It is only “second best” to existing drugs, competing with a “gold standard.”

It can be used by women without the assistance of a provider.

The Challenge of Multiple Indications

Misoprostol’s greatest clinical asset-the fact that it can be used for numerous reproductive health indications-also poses enormous challenges for implementation. As mentioned, misoprostol has many uses: to both prevent and treat postpartum hemorrhage, to induce labor, to induce abortion, and for post-abortion care. But these multiple indications pose two major challenges for implementation, one political and the other educational.

 

The political challenge lies in overcoming the stigma of abortion. A survey we conducted in 2010 of organizations that were working with misoprostol for postpartum hemorrhage revealed that the second biggest barrier to the introduction of misoprostol was its association with abortion. To quote one respondent who was asked about the challenges and opportunities for its introduction: “Hypersensitivity of misoprostol as an abortifacient [is a barrier]. We see this in clinical providers, government officials, even donors-a disproportionate concern that if misoprostol were to be made available for PPH prevention and treatment, it would be used for abortion. This is a major obstacle in accepting misoprostol for other OB/GYN indications-the abortion stigma.”

 

This political fear is strong, despite the evidence that all indications of misoprostol use are potentially life-saving. And because of this fear, there is a great deal of sidestepping going on as organizations begin to introduce misoprostol at the community level for postpartum hemorrhage while trying to stay clear of its potential use for abortion. “We feel there is tremendous promise for use of misoprostol for [postpartum hemorrhage], so we do not want to jeopardize that application by highlighting the other indications,” said another respondent.

 

The political controversy only exacerbates the programmatic challenge of informing women, their partners, and their health-care providers of the different doses and the proper timing of administration needed for different indications. This is usually facilitated by the registration and labeling of products in appropriate doses for each of misoprostol’s various indications.  

 

But because the vast majority of misoprostol use is currently done “off-label”(it’s being used for an indication other than the one the product is registered for) there is an urgent need to find ways to get women accurate information about how to use it for the different reproductive health purposes. Mobile technologies are beginning to open the information door to some women, but challenges remain. We need to find ways of achieving a broader level of knowledge about correct use, and to help women differentiate between the proper uses for each indication, including abortion.

 

The Challenge of Competing Against a “Gold Standard”

For both indications-abortion and postpartum hemorrhage-misoprostol is the second best option, up against another drug long considered the “gold standard.” For abortion, the most effective medical abortion regimen is mifepristone combined with misoprostol; when used together, the success rate is 93 percent, and when misoprostol is used alone it is 78 percent successful. Thus, where mifepristone is available, such as in the United States, it is the drug of choice.

 

In the case of postpartum hemorrhage, injecting oxytocin is the first line of treatment because, when oxytocin is at full potency, it is more effective than misoprostol. But oxytocin, unlike misoprostol, needs to be refrigerated. As a result, the quality of the drug is easily compromised by exposure to heat-a problem in many Global South countries. Finally, the administration of oxytocin requires that the women deliver in a health-care facility, another “gold standard” established by the medical community.

 

In reality, in many places in the world, we are not meeting these “gold standards,” in spite of decades of trying to do so. Mifepristone is far from universally available, oxytocin stock-outs are common in many places and/or the quality has been compromised, and many women continue to deliver at home, without skilled attendants. In these situations, misoprostol is a very good alternative and even has the advantage of being in pill form, making home use possible and safe.

 

Which brings us to the third challenging characteristic…

 

Women Can Use it Without the Assistance of a Provider

Another survey respondent summed it up nicely: “This is a gender issue. Misoprostol faces this unbelievable barrier because it is a drug for women.”

Therein lies both the greatest opportunity and the greatest challenge.  

 

Misoprostol has the potential to be a game-changer when it comes to maternal health precisely because it can be used safely and effectively by women themselves. The foremost obstacle to achieving MDG 5 is the weak health-care infrastructures of many countries. Misoprostol offers the opportunity to circumvent this obstacle for two of the three principal causes of maternal mortality-postpartum hemorrhage and unsafe abortion. Yet despite growing evidence that women can safely and effectively take misoprostol by themselves, in their homes, for both uses, health-care practitioners are insisting on controlling access to the drug, viewing it as an important addition to their clinical tool kit and a service only they can “provide” instead of as a pill that can be used by women, to help themselves, with little or no assistance from a health-care provider. The failure to relinquish control over the use of misoprostol not only gets in the way of women who are intent on helping themselves, it risks negating the most attractive aspect of this new technology: it’s self-use properties. To quote another respondent to our survey: “Many people are more concerned about what might happen with an intervention (i.e., side effects) than what might happen without an intervention (i.e., maternal death). In this case, women are more likely to be harmed by omission of the intervention than from any danger posed by the intervention itself.”

 

Obviously, as we work to make misoprostol available at the community level we need to acknowledge that it is a powerful drug and that incorrect use can lead to serious consequences-such as uterine rupture during labor induction. While some would use this as an argument for placing restrictions on access, we see this as a call to put accurate and comprehensive information about its safe use into the hands of women.

 

The Way Forward

This week policy makers from around the world are gathering in Malaysia at the third Women Deliver Conference to continue to share ways of reducing maternal mortality. Misoprostol is the single-best opportunity to do just that. But the true potential of this simple and cost-effective technology lies in our willingness to abandon our “provider” frame and put the pills directly in women’s hands. Our challenge is to let women be the shapers and the users of this new technology, not the beneficiaries of what we can provide or what we think they need. Can we stop worrying about women’s “misuse” or “abuse” of misoprostol and show that we truly trust women with their own reproductive health care? Let us remember that it was women who discovered this drug in the first place, specifically to circumvent the weakness of the health-care system. Let us give them back this powerful tool and get out of their way.  Our responsibility is to ensure that women have easy access to the pills and all the knowledge necessary to use them effectively and safely.

 

Argentina: Safe Abortion Hotline with Misoprostol

Great article in the Argentine newspaper Pagina 12, about a network of women, called Pink Rescue, who accompany other women in the use of misoprostol for safe abortion. They give information, advise about risks and help make sure the women get a checkup afterward.

Articulo excelente sobre Socorro Rosa servicio de acompañamiento de mujeres que están usando el misoprostol para abortar con seguridad. Dan información, consejan sobre los riesgos y ayudan a segurar que la mujer haga un examen de control despues.

http://www.pagina12.com.ar/diario/suplementos/las12/13-7899-2013-03-16.html

 

South America: Telephone hotlines mount fight against backstreet abortions

Mon, 25 Feb 2013 11:18 GMT

Source: Trustlaw // Anastasia Moloney

An activist dressed as a nun holds a placard that reads “they decided on your body” above pictures of the parliamentarians who are against abortion, during a rally outside a church in support of legalisation of abortion in Valparaiso city, about 121 km (75 miles) northwest of Santiago, September 28, 2012. REUTERS/Eliseo Fernandez

By Anastasia Moloney

BOGOTA (TrustLaw) – When Carolina answers an evening call in the Chilean capital of Santiago, she is acutely aware that she could be giving potentially life-saving information to a woman on the other end of the line.

Carolina is one of 30 self-described “militant feminist” volunteers who run an abortion hotline in Chile, providing information to women about how they can induce an abortion using the drug misoprostol.

The World Health Organisation recommends misoprostol, both taken on its own and combined with another drug mifepristone, as a safe and effective way for women to have an abortion in the first trimester of pregnancy.

In a country where abortion is a crime under any circumstances – even in cases of rape, incest or if the life of the mother or foetus is in danger – the hotline has become a lifeline, offering women a way to sidestep Chile’s blanket ban.

“Regardless of any laws, if a woman feels she needs an abortion she will get one. We know women in Chile have abortions every day. Abortion is a reality,” said Carolina, a volunteer at Lesbians and Feminists for the Right to Information, the Chilean group that runs the hotline.

“What we aim to do is to help women avoid having unsafe and clandestine abortions. The phone line is our strategy to fight that,” Carolina told TrustLaw in a phone interview in Santiago.

Originally invented as an ulcer drug, misoprostol induces an abortion by causing contractions of the uterus and is from 75 to 90 percent effective when taken correctly, WHO says.

Neither misoprostol nor mifepristone is risk-free and incomplete abortions can happen. But doctors say inducing an abortion with oral drugs rather than a surgical operation means it is less likely for an infection or a uterus perforation to occur.

UNSAFE ABORTIONS

In much of Latin America, Asia and Africa, restrictive laws or blanket bans on abortion force millions of women with unwanted pregnancies to have illegal and often unsafe abortions every year, according to WHO.

Some 47,000 women die from botched abortions each year around the world, says WHO. In Latin America meanwhile, deaths from botched abortions, often caused by severe bleeding, infections or a combination of both, account for 17 percent of maternal deaths in the region, the United Nations agency says.

That is why volunteers like Carolina are adamant it is vital to give women the information they need to stop preventable deaths from unsafe abortions.

“All women have the right to know about how to get a safe abortion,” Caroline, 32, said.

Since the hotline started in 2009, it has received more than 12,000 calls, up to 15 a day.

Sometimes it is a single mother of three who says she cannot afford to have another child. Other times, it is a young woman who does not feel ready to be a mother.

“We receive calls from young, old, poor, rich, married, single women, those with children and those without. Abortion is something that affects all kinds of women in Chile,” said Carolina, a sociologist.

Chile, like much of Latin America, is predominantly Catholic and the Catholic Church and conservative lawmakers argue that abortion infringes on the right of an unborn child, which should be protected by law at all costs.

Abortion, therefore, is both a taboo issue in Chile and a crime that can lead to imprisonment for those who perform abortions or assist on them. Because of this, hotline volunteers prefer to keep a low profile. They wear masks when promoting the hotline at public meetings and most choose not to give their full names.

It also means volunteers like Carolina are careful to only share public information with callers over the age of 18 based on a script approved by a lawyer.

“We don’t convince women to have an abortion. All women who call have already made up their minds to have an abortion,” said Carolina.

“We just provide women with information about how to have a safe abortion using misoprostol, correctly following WHO protocols.”

BLACK MARKET PILLS

On top of the country’s absolute ban on abortion, women in Chile face the additional challenge of getting hold of misoprostol.

The drug was pulled off pharmacy shelves in Chile, where it had been available with a prescription, under Michelle Bachelet, the former first female president of Chile, who now heads the U.N. Women’s agency.

It means women have to try their luck on the black market. It costs around $250 for the 12 pills needed for an abortion.

Chile’s safe abortion hotline was the brainchild of Dutch doctor and former Greenpeace activist, Rebecca Gomperts. Through her pro-choice group, Women on Waves, Gomperts has helped launch the abortion hotline in Chile, along with hotlines in Argentina, Ecuador, Peru and Venezuela.

“Medical abortion is such a revolution. Women …  can take their health, and life, in their own hands,” Gomperts told TrustLaw in an interview last year.

“PUSH AND PULL”

In Chile, any moves to decriminalise the country’s abortion laws are still a long way off, Carolina says.

“Chile is a very, very conservative country in all senses. The opinion of the Catholic Church holds a lot of weight in Chile. Maternity is seen as something sacred,” Carolina said.

“Currently, it’s not a priority among Chilean lawmakers to change the abortion laws and push for reform. Abortion isn’t an important issue in public debate.”

While there’s little headway on reproductive rights in Chile, elsewhere in Latin America attitudes have been changing.

In Colombia, for example, an absolute ban on abortion was partially lifted in 2006. A year later, abortion was made legal in Mexico City during the first 12 weeks of pregnancy and more recently last year in Uruguay.

“There’s a push and pull going on in Latin America,” Marianne Mollmann, a senior policy advisor on sexual and reproductive rights at Amnesty International, told TrustLaw.  “The countries that are stuck are Central America and Peru.”

As for Chile, the country remains a bastion for strict anti-abortion laws that force women to rely on underground activists and their telephone hotline to get a safe abortion.

 

 

Chile: Abortion Hot Line Is in Legal Gray Area

Taking Calls on Abortion, and Risks, in Chile  

 

By Aaron Nelsen   

Published: January 3, 2013  

http://www.nytimes.com/2013/01/04/world/americas/in-chile-abortion-hot-line-is-in-legal-gray-area.html?pagewanted=all&_r=1& 

  

Roberto Candia for The New York Times

Volunteers for the Safe Abortion Hot Line in Chile routinely wear masks when showing support in public for the organization in a country where abortion is illegal under any circumstances.

 

SANTIAGO, Chile – Every time the phone rings, Angela Erpel feels her nerves swell. Sometimes it is a scared teenager on the other end, or a desperate mother of three. There are the angry ones, too, with callers playing the sounds of crying babies or sending text messages with pictures of aborted fetuses.  

 

Then Ms. Erpel, 38, a sociologist who volunteers at Chile’s Safe Abortion Hot Line, gathers herself and settles into a familiar dialogue on the use of misoprostol, a drug that will induce a medical abortion.

 

“We don’t give them a moral guide or advice; we only provide information,” she said.

 

Since the hot line began in 2009, volunteers spread across this long, thin country have taken turns answering tense calls from women seeking information about abortion every evening from 7 p.m. to 11 p.m. There have been more than 12,000 calls so far, and they continue rolling in at a steady clip.

 

In a country where abortion is entirely illegal, even in cases of rape or when a woman’s life is in danger, the hot line is a risky endeavor. Operating in a legal gray area, volunteers face a daunting prison sentence if a conversation veers too far from a lawyer-approved script. The hot line already has had three lawsuits brought against it, though all were eventually dropped.

 

According to the law, having an abortion carries a penalty of 5 to 10 years in prison, depending on the circumstances, while doctors and others who perform an abortion or assist with one could face up to 15 years, prosecutors say. In practice, however, fewer than 500 cases have been prosecuted over the last several years.

 

“I think there is a certain sensitivity to the social conditions behind these abortions, such as poverty or rape or teenage pregnancy,” explained Paula Vial, a lawyer and former public defender in Santiago.

 

Beyond the legal consequences, the 30 hot line volunteers are keenly aware of the social ramifications of taking an active role in such a polarizing issue. They wear masks when promoting the hot line at public gatherings, and are often vague about the details of their volunteer work in their daily lives. Many fear losing their jobs or driving a wedge into personal and family relationships. Indeed, Ms. Erpel was the only volunteer willing to go on the record about her work with the hot line, and even she is usually circumspect about it.

 

“It’s complicated,” she explained. “I’m open about being in an organization, but not necessarily that I work directly with abortion.”

 

Abortion was not always a clandestine affair in Chile. The current law that strictly bans it was one of the final acts of the dictatorship. In 1989, shortly before relinquishing power, Gen. Augusto Pinochet ended a tradition of legal abortion dating to 1931, in which a pregnancy that threatened a woman’s life, or a fetus that was not viable outside the womb, could be terminated. Chile’s law now is one of the strictest in the world.

 

By contrast, Uruguay legalized abortions in the first trimester for any reason last October, joining Guyana and Cuba as Latin American countries with broadly legalized procedures. Abortion is also legal in Mexico City. But Chile has remained a socially conservative country, after 20 years of economic growth and the election in 2006 of a woman as president.

 

“The hierarchy of the Catholic Church has had a very strong influence in public policy,” said Claudia Dides, a spokeswoman for the Movement for the Legal Interruption of Pregnancy.

 

In a pivotal case in 2008, Karen Espíndola, then 22, learned in her 12th week of pregnancy that her fetus had holoprosencephaly. Fetuses with the condition have a single-lobed brain, and most die before they are born. It is a common reason for terminating a pregnancy.

 

Ms. Espíndola sought an abortion, appealing to the president and setting off a national conversation over abortion. In February 2009, Ms. Espíndola gave birth to Osvaldo, who died in 2011.

 

“In reality he was never conscious he was alive,” she lamented. “He fought to breathe; he was fed through a tube. We all suffered a lot. Nobody here is a winner.”

 

Chile has witnessed a swell of liberal social movements in recent years, with gay men and lesbians pressing for the country’s first hate-crime legislation, environmentalists stalling dam-building projects in Patagonia, and students pushing for an overhaul of the education system.

 

Advocates contend that abortion rights sentiment bubbles near the surface as well, but the government has pushed back.

 

After criticizing the abortion hot line in the news media, the Ministry of Women started a hot line of its own. It is attended by psychologists and social workers who answer calls from men or women looking for information or support when facing what the ministry calls an “abortion situation” or “post-abortion syndrome.”

 

“Maternity, one of the most satisfactory experiences in the life of a woman, can go through difficult and desperate moments,” Minister Carolina Schmidt said at the time the government hot line began.

 

Other influential anti-abortion organizations offer to guide women considering abortion away from the procedure.

 

“If you help that person define what is troubling them and making them think of an abortion, and together you find a solution, in the end the person decides for life and her child,” said Victoria Reyes, director of assistance for Foundation Chile United. “We are convinced the second victim of abortion is the woman; the woman who has an abortion carries that guilt.”

 

The government reported several hundred adoptions in 2011, but it estimates 120,000 abortions, in a country with a population of about six million women from 15 to 64 years old.

 

Misoprostol, sold under the brand name Misotrol in Chile, has changed the way many of those abortions are performed. The drug was originally developed as an ulcer medication, and its warning label advised that, in excess, misoprostol would cause a woman to miscarry. Before long, women in countries with little or no access to safe abortions were using the drug to do that very thing.

 

Misoprostol “is a revolution for women,” said Rebecca Gomperts, founder of the Dutch organization Women on Waves. “Even where abortion is illegal and women don’t have a doctor, or they are poor, they still have a way to do a safe abortion.”

 

The abortion hot line is Ms. Gomperts’s creation. A medical doctor and former Greenpeace activist, she realized in 1999 that it was possible for a ship sailing under a Dutch flag to take women from countries where abortion is illegal to international waters to administer misoprostol.

 

Before departing Chile, Women on Waves helped set up the abortion hot line, training volunteers how to discuss misoprostol according to World Health Organization guidelines.

 

There are now five abortion hot lines in South America: in Argentina, Chile, Ecuador, Peru and Venezuela.

 

Misoprostol was taken off pharmacy shelves in Chile under Michelle Bachelet, the former president who now runs the United Nations’ agency for women’s advancement, so access to the drug is almost entirely a black market transaction.

 

Dozens of Web sites offer misoprostol at exorbitant prices, and sometimes of dubious quality.

 

One 29-year-old lawyer who became pregnant a few months ago said she paid $300 for the necessary 12 pills.

 

“To meet someone in a clandestine place, hoping they aren’t a police officer, wondering if they are even giving you the right pills, knowing that you could go to prison when all you want to do is exercise your right as a woman is horrifying,” the lawyer said on the condition of anonymity to avoid prosecution.

To its volunteers, the Safe Abortion Hot Line stands as a simple equation – 30 women and a single cellphone that gets passed among them. This month, they expanded: they released an abortion manual on using misoprostol.

 

Occasionally, women call back the hot line after a successful abortion, but more often the volunteers never know the outcome.

 

“That’s always the hardest part,” Ms. Erpel said.  

 

Computer App to terminate a pregnancy using Misoprostol

Missed Your Period? Don’t Want to be Pregnant? There is an App for That

 

by Karen Gardiner

December 3, 2012

 

http://www.rhrealitycheck.org/article/2012/11/29/missed-your-period-there-is-medication

 

Via www.ipas.org

 

 

“To avoid judgement and fear, it is always useful step into the shoes of another person. I invite you into mine.”

 

So begins the journey of a 19-year-old Mexican named Claudia, protagonist of an inventive computer game.

¿No Te Baja? which translates as Missed Your Period? makes use of bright colors, engaging cartoon characters and relatable, non-technical, language to inform and guide users through the steps they can take to terminate a pregnancy using Misoprostol. The website takes the form of an interactive, Choose Your Own Adventure style game, where users click through to different scenarios that change according to their own personal situation and decisions.

 

Misoprostol, a drug used to treat ulcers, is easily available for purchase throughout Mexico, and, unlike in the United States, does not require a prescription. Use of Misoprostol to terminate pregnancy is widespread in parts of Mexico where abortion is illegal, but pharmacy workers often lack the knowledge of how the drug should correctly be administered — and criminalization means that helpful information is scarce.

 

Although abortion of up to 12 weeks of pregnancy is available on demand in Mexico City, the situation is quite different in the rest of the country. In fact, Mexico City’s 2007 legalization of abortion prompted a backlash from 17 other states, which passed amendments stating that life begins at conception, ushering in a much stricter enforcement of already existing anti-abortion laws.

 

Users of No Te Baja, through the actions of Claudia and her boyfriend, go through each detailed step of the process of self-administering a medication abortion: from the initial pregnancy test to the decision whether or not to involve the partner; the signs and symptoms of an ectopic pregnancy to calculating gestational age to indicate whether or not use of Misoprostol will be effective-and if it will be safe to self-administer.

 

The game advises that Misoprostol can be purchased in most pharmacies and that it may be sold under various other commercial names including Cytotec, Cyrox, and Tomispral.  Users receive detailed information on how to administer Misoprostol through the mouth or the vagina, noting that, in the event of having to seek medical attention, medical personnel would likely be able to detect the remnants of the pills inside the vagina- important information for women living in areas where they can be prosecuted for inducing an abortion.

 

The central Mexican state of Guanajuato, where hospital staff report suspicious miscarriages to the police, is one such place. The Nation described the state’s approach to dealing illegal abortion in a January 2012 article by Mary Cuddehe:

 

“The state has opened at least 130 investigations into illegal abortions over the past decade, according to research by women’s rights groups, and fourteen people, including three men, have been criminally convicted. Given Mexico’s 2 percent national conviction rate during its most violent period since the revolution, that’s a successful ratio.”

 

No Te Baja doesn’t end with the final dosage of medication: users (and Claudia) are informed of what signs to look out for that would require medical attention, and of how to tell if the abortion is incomplete. The final stages of the game offer information on how to avoid another unplanned pregnancy with detailed descriptions of different methods of contraception.

 

Chile: Líneas telefónicas promueven el aborto seguro en Sudamérica / Telephone lines promote safe abortion in South America

In Spanish, but here is a Google translation in English

 

http://www.elciudadano.cl/2012/11/10/59785/lineas-telefonicas-promueven-el-aborto-seguro-en-sudamerica/

Líneas telefónicas promueven el aborto seguro en Sudamérica

Hartas de las restricciones impuestas a los cuerpos femeninos, colectivas e individualidades sudamericanas han optado por la acción directa a través de líneas telefónicas autogestadas que guían a las mujeres a tener un aborto seguro con pastillas. Otra estrategia para llegar a la ansiada y necesaria despenalización total.

La Organización Mundial de la Salud (OMS) calcula que anualmente en el mundo se practican cerca de 20 millones de abortos de alto riesgo y que el 99,9% de la mortalidad materna por aborto en condiciones de ilegalidad ocurre en los países no desarrollados. Por esta razón, cada 28 de septiembre miles de mujeres americanas y caribeñas se manifiestan por su despenalización, que en la región suma cuatro millones de casos al año, en un marco de legislaciones restrictivas y criminalizadoras.

Desafortunadamente, Chile, junto a Nicaragua, El Salvador, Honduras y República Dominicana, son los únicos países latinoamericanos que prohíben el aborto en cualquier circunstancia. Otros aceptan la interrupción del embarazo por razones terapéuticas o de violencia sexual, pero concretarlo implica superar todos los obstáculos impuestos por la burocracia médica, los sectores políticos conservadores y la iglesia.

TENGO UN GRAVE PROBLEMA

Según la propia OMS, el misoprostol (o misotrol) es la manera más segura para quienes deseen abortar sin complicaciones hasta las doce semanas, aunque su uso original es la prevención y tratamiento de las ulceras gástricas. Como potencial abortivo, en nuestro país se vende con receta, pero el mercado clandestino es amplio.

Por esta razón, en 2009, la agrupación Feministas Bio Bio replicó una inédita experiencia en estas tierras: la Línea Aborto Información Segura (LAIS), un servicio autogestionado de telefonía donde llaman mujeres que necesitan orientación para abortar de manera segura con misotrol. Rápidamente, fue necesario congregar más gente y el proyecto se hizo extensivo a Iquique, Valparaíso, Santiago, Temuco y Valdivia, lugares desde donde se contesta actualmente el teléfono.

“Decidimos responder con algo concreto y más radical, ya que no se ha avanzado nada desde la legalidad y se ha retrocedido en la concepción que tiene la gente sobre el aborto. La línea, además, es una estrategia para avanzar hacia la despenalización”, explica Zicri Orellana, de Lesbianas y Feministas por el Derecho a la Información, agrupación que hoy se hace cargo de la línea en la capital penquista, y que también realizan talleres y se aprontan a sacar un par de publicaciones relativas al tema.

“Apuntamos a que el aborto deje de ser un crimen, que no es lo mismo que la legalización, porque eso implica que el Parlamento defina bajo qué condiciones las mujeres pueden abortar. A nosotros nos interesa abortar cuando se nos de la gana: en nuestra casa, con nuestras amigas, de manera autónoma”, agrega.

Las telefonistas son voluntarias y están capacitadas para responder las dudas. Contestan desde las 7 de la tarde a las 11 de la noche, ya que todas son trabajadoras o estudiantes. “Informamos sobre cómo usar las pastillas, una vez que ya se han conseguido; no las vendemos. Por lo mismo, también ayudamos a identificar si son falsas”, explica.

No preguntan nada, sólo entregan información. Los datos entregados espontáneamente por las 10 mil llamadas acumuladas en sus tres años les permiten identificar un perfil: llaman mujeres desde 18 hasta 40, estudiantes y trabajadoras, madres, inmigrantes; a veces llaman sus parejas, pero no se entrega la información a hombres.

Zicri explica que ha habido 3 o 4 intentos de criminalizar la línea, pero no han fructiferado: “buscaban saber si vendíamos pastillas y si damos la información a menores de18 años, lo que no hacemos. También se intentó acusarnos de asociación ilícita, de inducción al aborto y de apología al delito, pero ninguna de estas denuncias fue admitida”.

Sin embargo, el Estado chileno si ha criminalizado a una niña de 15 años de la Octava Región, quien tras ocultar un embarazo producto de incesto, de violaciones y abusos sexuales, tuvo un parto adelantado en el que murió el feto. Hoy se encuentra esperando un veredicto judicial que manchará sus papeles de por vida y estigmatizada como infanticida por los medios de comunicación masivos.

LARGA DISTANCIA INTERNACIONAL

Pero la línea nacional tiene sus raíces en la experiencia ecuatoriana nacida en 2008. En la actual Constitución de ese país, vigente desde 2008, los casos de aborto no punibles son en caso de que el embarazo ponga en peligro la vida o salud de la mujer, y cuando este sea producto de una violación a una mujer demente o idiota. Datos de la OMS indican que en el país hermano cada cuatro minutos aborta una mujer.

Esta alarmante cifra inspiró la creación de la línea Salud Mujeres Ecuador, “ante la necesidad de que las ecuatorianas puedan acceder a información sobre aborto seguro, frente a la inoperancia del Estado en tratar este tema”, indican desde la Coordinadora Política Juvenil por la Equidad de Género. La dinámica y los horarios de atención son casi iguales a los de Chile.

Sus estadísticas muestran que el 35% de mujeres que llamaron a la línea tenían entre 18 y 22 años, siendo el promedio de edad de las mujeres que llamaron 20 años.

En Septiembre de 2010, la línea fue suspendida por orden de la Fiscalía, quien había recibido una denuncia y una orden de investigación por parte de la Comisión de Salud de la Asamblea Nacional. Las activistas buscaron otro número, que sigue funcionando, y la denuncia quedó en nada.

Además de talleres, trabajan con otras organizaciones y pertenecen al Frente Ecuatoriano por los Derechos Sexuales y Derechos Reproductivos, “desde donde hacemos lobby en la Asamblea Nacional, para presionar en el tema coyuntural que es el Aborto por Violación”.

En el caso argentino la línea “Aborto: más información, menos riesgos” surge en 2009 “para facilitar la independencia de las mujeres, ante la mirada hegemónica médica que se cubre detrás de una ley, para establecer un doble discurso que les de ganancia económica. También para politizar el lesbianismo desde un lugar diferente al del matrimonio igualitario y la maternidad”, señalan sus coordinadoras.

Datos del Ministerio de Salud cifran entre 500 mil y 600 mil el número de mujeres que abortan al año en ese país, lo que quiere decir que toda mujer, en promedio, aborta dos veces en su vida.

HORIZONTES

Los contactos internacionales y los números de las tres líneas son similares: entre 10 mil y 15 mil llamadas desde su funcionamiento; 10 a 15 llamadas por día. Sin embargo, las perspectivas van más lejos. “Nuestro trabajo como colectiva va encaminado a la despenalización total del aborto, legal y socialmente. Queremos que el Estado garantice el acceso a todas las mujeres a un aborto, legal, gratuito y seguro en los hospitales públicos, lo que va de la mano con una educación sexual integral y con real acceso a métodos anticonceptivos”, explican desde Ecuador.

“No queremos hacer educación sexual porque no nos corresponde, aunque podemos aportar con nuestra experiencia. Lo que nos interesa es informar que el aborto se puede prevenir si los hombres usan condón, y si siendo mujer, eres lesbiana”, indica Zicri Orellana de la línea chilena.

“Buscamos que el misotrol se incluya gratuitamente en la provisión estatal y se promueva la investigación científica para mejorarlo”, dicen desde Argentina.

Para todas ellas el cómo abortar debiese ser un contenido mínimo de la educación, porque hoy el nivel de información es muy precario. “Hay mujeres que llaman a la línea diciendo que quieren abortar porque la noche anterior tuvieron una relación sexual y no se cuidaron. Es decir, ni siquiera saben que existe la “pastilla del día después”. Hay mujeres que no tienen idea de nada y eso no puede seguir pasando”, concluye Zicri Orellana.

El número de la línea en Chile es 889 18 590

+ INFO:

www.womenonwaves.org

Por Cristóbal Cornejo

El Ciudadano

 

Northern Ireland: Woman jailed for eight years for self-induced abortion

 18.09.12

A woman has been jailed for eight years at Leeds Crown Court for obtaining an abortion at 39 weeks of pregnancy in 2009.

Sarah Catt, of Sherburn-in-Elmet, North Yorkshire is believed to have become pregnant following an affair with a colleague. She discovered she was 30 weeks pregnant following a scan at a Leeds hospital and later claimed to have had a legitimate abortion at a local clinic.

Investigation of her computer revealed however that she had purchased medication used to induce labour on the internet.

Catt, who is married with two children, told a psychiatrist she had taken the drug while her husband was away and delivered the baby boy by herself at home. She claimed the child was stillborn, but has refused to reveal the location of the body.

Catt pleaded guilty in July to administering a poison with intent to procure a miscarriage.

Evidence presented in court suggested a complex history of pregnancy and childbirth: Catt gave up a child for adoption in 1999, she later had a termination with the agreement of her husband, tried to terminate another pregnancy but missed the legal limit and concealed another pregnancy from her husband before the child’s birth.

Sentencing her to eight years in prison, the judge said Catt had made a “deliberate and calculated decision” to end her pregnancy.

Ch Insp Kerrin Smith, who led the North Yorkshire Police investigation, said “Catt has proved to be cold and calculating and has shown no remorse or given an explanation for what she did.”

Commenting on the case Abortion Rights said:

“This is a sad and unusual case and one that highlights the desperation women can feel when faced by an unwanted pregnancy and when they feel their options are closed.

The upper legal time limit for abortion in this country is 24 weeks in most cases, and while we do not condone anyone operating outside the law, the case underlines how vital it is for women to have access to safe, legal abortion as early as possible in pregnancy.

The reason why we do not see situations like this in the UK is because in the vast majority of cases women do have access to high quality abortion services and good advice on their pregnancy options.

Sarah Catt is clearly a very troubled individual, with a complex medical history. An eight year jail term in such a case is disproportionate.

Women who find themselves in what seem like impossible circumstances must be treated with understanding and compassion, and offered treatment if appropriate, not threatened with prosecution.”

 

‘Misoprostol – Must for Reducing Maternal Mortality’

http://www.ipsnews.net/2012/09/misoprostol-must-for-reducing-maternal-mortality/

By Zofeen Ebrahim Reprint |    

KARACHI, Sep 12 2012 (IPS) – “I can’t imagine life without misoprostol,” says Dr. Azra Ahsan, a gynaecologist and obstetrician who has, for more than a decade, been using the controversial drug to stop women from bleeding to death after delivery.

Originally intended for treating gastric ulcers misoprostol has since 2000 been gaining in popularity for its ability to induce labour and stop post partum haemorrhage (PPH).

“I knew that it can save women from dying long before 2009 when it was registered for use in Pakistan,” said Ahsan, a member of the government’s National Commission on Maternal and Neonatal Health.

WHO guidelines advocate the use of misoprostol against PPH, while the International Federation of Gynaecology and Obstetrics (FIGO) suggests using the drug in situations where regular ‘uterotonic’ drugs like oxytocin and ergometrine are not available.

Doctors like Ahsan are dismayed at moves to get WHO to reverse its listing in April 2011 of misoprostol among essential medicines that “satisfy the healthcare needs of the majority of the population” and are  “available at all times in adequate amounts and in appropriate dosage forms, at a price the community can afford.”

Findings of scientific studies published in the August issue of the Journal of the Royal Society of Medicine are being cited in suggesting that WHO should “rethink its recent decision to include misoprostol on the essential medicines list.”

Allyson Pollock, who led the study, stated that there is insufficient evidence to suggest that misoprostol works in preventing PPH. Instead, she urges poor countries to improve primary care and prevent anaemia to lower the risk of haemorrhage following delivery.

Ahsan, however, says that in Pakistan some 80 percent of pregnancy cases end up with the mother’s uterus failing to contract naturally after delivery, calling for the use of uterotonic medicines to reduce bleeding.

“Nearly 27 percent of maternal deaths in Pakistan are caused by excessive blood loss after childbirth,” Ahsan explained to IPS.

According to the latest Pakistan Demographic and Health Survey (2006), Pakistan’s maternal mortality ratio stands at 276 for every 100,000 live births, and is among the highest in South Asia.

Bleeding, the leading cause of maternal deaths worldwide, is defined by the WHO as blood loss greater than 500 ml following a delivery.

The fact that misoprostol is also misused in Pakistan – and other developing countries like Brazil – to induce abortion cheaply, has added to controversies over the drug.

“I don’t care if people think it is used, misused or even abused…I know it saves mothers from dying,” says Ahsan.

Unlike other uterotonics, misoprostol has the advantage that it does not need refrigeration for storage and can be easily administered orally by trained birth attendants, Ahsan said.

A joint statement by FIGO and the International Confederation of Midwives states: “… in home births without a skilled attendant, misoprostol may be the only technology available to control PPH.”

Zulfiqar Bhutta, head of women and child health at the Aga Khan University, Karachi, and member of the independent expert review group for maternal and child health to the United Nations secretary-general, agrees with Pollock that misoprostol needs to be evaluated more robustly.

“But I wouldn’t throw out the baby with the bath water yet,” Bhutta told IPS. “There is a need to increase its use in the right circumstances and also carefully monitor misuse. It is no magic bullet and should not lead to complacency in provision of essential maternal services,” he said.

“I think the point of the paper published recently is to try and separate  science from messianic zeal,” says Bhutta who is also co-chair of ‘Countdown to 2015’, a global scientific and advocacy group tracking progress towards the U.N. Millennium Development Goal Five pertaining to maternal health.

“Misoprostol is promising and we should do our best to evaluate its safe use,” said Bhutta. “But, there are people in Pakistan who are recommending large scale distribution to families for use in all births. Will this be cost-effective or indeed safe?”

Pollock’s study has stirred international concern. International Planned Parenthood Federation’s Upeka de Silva told IPS in an e-mail that if WHO withdraws misoprostol, it would mean “countless women will be denied life-saving care and forced to suffer pregnancy-related complications which are entirely preventable.”

“We are fully aware that all studies have limitations and that continued research on best practices for maternal care is needed,” de Silva said.

“However, for the purposes of meeting the urgent needs of women, particularly in rural, underserved communities, we are confident about being guided by the abundant literature and expert evidence supporting the safety and effectiveness of misoprostol for multiple reproductive health indications,” de Silva said.

Further, she said: “The increasing number of clients provided with safe abortion services, treatment for incomplete abortion and PPH through clinics run by our member associations is further evidence that misoprostol should remain available and accessible.”

“It’s alright to stir confusion sitting in cushy offices, but the ground reality in Pakistan is quite different,” said Ahsan. “The conditions we work under are very, very constrained…let’s not forget the hot temperatures and long power outages (causing refrigeration failure).”

 

Devil in the detail: abortion drug [misoprostol] banned in Turkey

by Stratos Moraitis | July 16, 2012   The Globe Times/Advocating Human Rights   http://www.theglobetimes.com/2012/07/16/devil-in-detail-abortion-drugs-banned-in-turkey/   Pursuant to a month of heated discussions, Turkish government stated that they will not amend the existing laws on abortion in Turkey and restricted their changes to the subject of making caesar sections more difficult to implement. Social media whirled about a few days, press immediately forgot about the issue, but the snake never slept.   Since the debate was bipartisan and centered around the poles of who said what and belonged to which group, a subject so complicated and without a widespread consensus ended up being imprisoned within the walls of daily agenda. No real public discussion was enabled; the opinion makers yelled and gagged and powers to be let it go on while preparing for their real scheme.   Since the leader of the governing party made it clear that their “religious and vindictive” new youth should increase in numbers, abortions and family planning should be abolished. This author is fully aware of the fact that his rhetoric is exactly that and nothing more. But in reality AKP government and the state machinery need ignorant, scarcely educated majority to increase as a percentage of total population to guarantee their political and social existence. Since level of education and economical wealth has an inverse relationship with the number of kids in households, their “3 children minimum for each family” motto will evidently succeed only in undereducated and ill-informed population, increasing their vast numbers even more.   So while arguing publicly that the government has no immediate plans to ban abortion, Ministry of Health banned all drugs containing misoprostolused in medical abortion on July 9th with instructions by Turkish Medicine Informations Network. World Health Organisation declares that misoprostol can be used safely to induce an abortion up to nine weeks of pregnancy and places the substance on the List of Essential Medicines. In Turkish pharmacies medicine containing the banned substance-misoprostol; Arthrotec (used in osteoarthritis and rheumatoid arthritis treatment) and Cytotec (used in peptic ulcer and Gastroesophageal reflux disease treatment) are banned now. Turkish government is simply preventing ulcer and arthritis patients’ access to affordable treatment with no literature or explanation behind their decision to prevent medical abortions. No other drugs enabling medical abortions that contain Misoprostol or Mifepristone are available in Turkey.   Public fury started after Turkish Prime Minister’s mention that abortion is an equivalent of mass murder in a public speech. Turkey experienced historically very high death rates in pregnant women prior to the legalization of abortion in the early eighties. However, being a country with feudal traditions death rates among young women due to family feuds and sexual issues are still relatively high. With the influence of the rise of conservative values in the society death rates among women increased 1400% during the last seven years according to the Justice Department. Women’s Rights is a severe issue in Turkish society where women even when they are economically independent, are frequently abused by men due to the social and traditional factors. Even according to the existing abortion law, the right to undergo the operation is dependent on husband or father’s approval.   In Turkish politics devil is always hidden in detail. Rhetoric and reality does not usually match. The love story between engineering of the society and the ruling elite does not seem to fade away any time soon. While managing the public euphoria and the demands of society at large, the officials follow an unwritten strategy of oppression based on the changing needs of time. As we go through the commercialization of everyday life in Turkey with increasing number of shopping malls and conservatism on the rise, it has been the management strategy of the new elite to blackmail the society with economic growth: “obey, become one of as and prosper.” This strategy helped limit the fight for human rights to ethnic and religious minorities that refuse to join conservative ranks.   And with new pressures applied on freedom of women, religious, ethic or sexual minorities everyday, another “modern” era of assimilation is underway.   The state as a supplier of amenities decides who shall receive the charity and who is to be shunned. In a country which calls itself a democracy that is unthinkable. But then again, when you have a closer look, and feel how the Sunni Muslim elite takes on daily issues, the devil’s shining golden teeth grins between each golden ornament in the framework. With gratitude to Duygu Kara and Rebecca Gomperts for their insight.

 

Indonesia: Activism and Violence

Unspoken Violence on Abortion, a Case Study of Indonesia

by Samsara YK on Friday, June 15, 2012 at 3:43am ·

By : Inna Hudaya & Zulkamal Hidaayat Zakaria

 

Introduction

Most people in Indonesia has been viewing abortion as an immoral action because it against the positive norms of society. As some countries did, Indonesia preserves cultural and religious based principles which support a banning on abortion. For sure, abortion is illegal in Indonesia. Unfortunately, the government seems unaware of the side effect of such policy and fails to communicate majority and minority interests which are involved. Majority is people who support government policy on banning abortion and minority is people who against government policy on banning abortion. In this setting, the government and society also failed to identify women as a victim of the government policy. This policy has disposed women who commit abortion as criminals. Those women have been dealing with people who can’t accept abortion although it is associated with women authority over their body and future. As a result, women are more vulnerable to violence because the policy has labeled women who commit abortion as criminal instead of victim.

 

Criminalization of Abortion

The important point in understanding abortion issue in Indonesia is to recognize that it is illegal but it can be done for some specific reasons. Abortion is illegal but it can be done if the pregnancy will jeopardize the mother or fetus and if the pregnancy is caused by rape. This abortion can be taken before the gestational age of six weeks unless to save mother’s life. Even if it is possible to have an abortion until 6 weeks of gestational age, women still do not have authority over their own decision. For instance, married woman needs consent from her husband and unmarried woman needs a parental consent. In case of rape, the parental consent needs to be given with the approval statement from psychologist or psychiatrist.

 

Based on the Health National Law No 36/2009, the penalties were 10 years imprisonment or a fine of 1 billion IDR for anyone who had induced abortion. In fact, due to the restricted access on sex education, reproductive health and health service especially contraception, women are more vulnerable to unwanted pregnancy that leads to the need of safe abortion.

 

Women who are young, unmarried, less educated, poor and living in rural area, are the most vulnerable groups and severely affected while dealing with unplanned pregnancy. At this point, unsafe abortion is the available and accessible option for them. On the other hand, the criminalization of abortion did not impact only on the number of unsafe abortion and maternal mortality but it had created many kinds of violence toward women’s rights. This policy has provided an open chance for industry of abortion to develop. Most of abortion clinics in such industry are illegal, especially in Java Island. Those clinics provide abortion services for women without the considering the rights of patients. Women were taking for granted in this situation. Moreover, many drug dealers used to cheat on women who could not report it to the police because abortion is illegal. Frankly, the circumstance has been creating many forms of violence and problem toward the issue of abortion to grow.

 

Based on the facts above, criminalization of abortion is violation against women rights instead of solution. The government policy was not only possessing women as an object of violence but it was also letting people to take advantage on the situation of women itself. It is hypocrisy of nation who they believe that abortion is sin and create other forms of sin which is violating women rights.

 

Criminalization of abortion is not a proper way to reduce the number of abortion. On the contrary, this policy made violence toward women remain unspoken. The only way to reduce the number of abortion is by giving sex education and reproductive health and an open access to health services so women will have a control over their sexual and reproductive life that will protect them from unwanted pregnancy.

 

SAMSARA Project for Change: Reclaiming Access to Safe Abortion

While the government and society failed to identify women as victim from the ongoing policy, women died and suffered from complications caused by unsafe abortion. There’s no time to wait any longer for the government to take action in saving women’s live. Saving the life of women doesn’t always mean to save women from severe complications, traumas, depressions and maternal deaths. Life also means the quality of women’s living condition which includes access to education, health, economy and bargaining position. Based on the situation in Indonesia, the most important thing is a real programs and strategies that will help women to access safe abortion services and create a supportive network in society to reduce stigma and discrimination. In the future, the social changes are expected to decriminalize abortion in Indonesia.

 

SAMSARA, an organization based in Yogyakarta has been working to promote the reproductive health, sexuality, gender, spirituality, culture and human rights on abortion issues. SAMSARA also provides access to education, information and counseling on abortion based on sexuality and reproductive health and rights. Through its work, SAMSARA has found an urgent need to inform and empower women so they have sufficient knowledge and support to choose and access a safe abortion. We believe that changes are indisputably needed, not only by supporting and empowering the women but also taking a pro active part in providing education to people; influencing social movements; expanding discourses and strengthening a supportive network.

 

Since 2008, we started a program called Safe Abortion Hotline where we assist women in making decision and finding a safe clinic for abortion. Actually, women should find the clinic of abortion by themselves. Our main job in this program is to provide advice to women to recognize a reliable abortion clinic, affordable, meets the medical standard and avoid them getting deceived by service provider. Mostly, women have to go through the process by themselves without any companion. In this situation, the hotline is available to assist women in the process.

 

 

In 2011, we integrated a Medical Abortion into the hotline program. The hotline promotes the use of Misoprostol which is one of recognized method in medical abortion as an alternative option for safe abortion until 9 weeks pregnancy. Hotline is assisting women in making decision, provide information and open access to safe abortion. In this hotline program, women need to confirm their decision before the hotline counselors refer them to service provider or assist them to have abortion at home. It is necessary to ensure that abortion is the decision of the women, not the decision of her partner or family.

 

If the women can access clinic, hotline will refer women to have surgical abortion. But most women can’t access a clinic because of the distance and price. Most women choose medical abortion. Once women get the pills, a counselor will be available by phone to assist women when women have abortion at home. Usually counselor will ask women to make notes about the process so all information will be helpful for following up the consultation process. Follow up consultation is needed to ensure that the abortion is completed. Hotline also works on the improvement of its service to help women in every step so they won’t face abortion by themselves when it is being taken.

 

Between May 2011 to May 2012 we received 1.425 calls, emails and face to face session. 71,1 % of the clients are unmarried women. SAMSARA considers Medical Abortion as an ultimate option for safe abortion in a restricted setting like Indonesia. Medical Abortion is not only cheaper, but it also protects the privacy of the women, gives full control and authority to the women and encourages women to focus and care over their body.

 

Safe Abortion Hotline is an action in reclaiming access to safe abortion. Since our government failed in respect, fulfill and protect women life, it is a time for civil society to act. The absence of real actions to change the circumstance will remain the unending violence on abortion for women. We can’t rely on government to saves women in crisis. Only by listening, supporting and working together, with or without government assistance, we can save women life. The choice is ours, whether to let the unspoken violence to continue or to change the unjust to a just world.