Health
All about the
Abortion Pill
by Deepti Priya Mehrotra
With Pope Benedict reportedly telling a recent convention of Roman
Catholic pharmacists to help protect human life from conception until
natural death and "avoid collaborating... in the supply of products
which have clearly immoral aims, for example abortion or euthanasia",
the abortion pill has drawn attention once again. The pill, not
authorized in Italy, is available in many European Union countries since
the 1980s; in the United States since 2000; and in India since February
2002.
"An abortion pill is definitely a safe and a better option over surgical
abortion - provided the pregnancy is less than seven weeks. Any time
past seven weeks requires surgical abortion," explains Dr Duru Shah,
Consulting Obstetrician and Gynecologist, Mumbai. He adds that post
seven weeks, the pill can lead to partial abortion: part of the
pregnancy tissue might remain in the uterus. This can cause severe
infection, which, if not treated, could lead to cancer.
People often confuse the abortion pill with the morning-after pill. The
latter is a contraceptive; one dose of the same is required to be taken
within 72 hours of sexual intercourse. The morning-after pill is
available over-the-counter, since medical supervision is not considered
essential. On the other hand, the abortion pill should be taken only
under strict medical supervision as it could result in heavy bleeding.
Ironically, many people imagine the abortion pill to be a kind of magic
wand that will accomplish a vanishing-act as regards an unwanted fetus.
Such grossly misinformed views are evident in the following submissions
to the DoctorNDTV (a popular TV channel's health portal) website:
"According to me, morning-after abortion pills should not be freely
available at chemist shops because it will encourage prostitution,
extra-marital and pre-marital affairs..." says one. However, according
to another, "There is nothing of misuse of this medicine in my view. As
the desire for sex is ultimate, so when sex cannot be avoided, then
there should be surely some safe side... So, this pill should be
available freely."
In the wider ethos of misinformation regarding all matters sexual, the
abortion pill, in fact, has been misused. At a national experts meeting
held at AIIMS (All India Institute of Medical Sciences, New Delhi) in
October 2002 to frame guidelines for the abortion pill, Dr. J.V.R.
Prasada Rao, then Secretary, Department of Family Welfare, said, "I have
got reports that it was available even at 'paan' (betel leaf)
shops in Mumbai. Reports of complications and misuse has made a monster
out of a safe drug which has forced us to formulate guidelines."
The abortion pill is that it is actually two different drugs, to be
taken in combination. The first drug, RU-486 or Mifepristone, is taken
after pregnancy has been confirmed. The second drug, Misoprostal, is
administered after another 48 hours or so.
However, before any woman takes the abortion pill, high-risk factors
must be ruled out. These include anemia (hemoglobin less than 8 gm per
cent), cardiovascular disease, chronic adrenal failure, uncontrolled
seizure disorder, severe liver, renal or respiratory disease, and a
history of taking aspirin, steroids or antidepressants. The pill is also
not advisable for HIV+ persons, or for heavy smokers. Caution is to be
exercised in patients with fibroid uterus or previous surgery on uterus
or cervix.
Clearly, the abortion pill is not an uncomplicated method. There are a
lot of dos and don'ts attached. In any case, no abortion method should
be considered a regular alternative to contraception. If pregnancy is
not wanted, it is best prevented. But since no contraceptive method is
foolproof, we do need accessible abortion methods. Women worldwide have
won the right to abortion after intense struggle and it is important to
protect this right.
Interestingly, at a consortium on National Consensus for Medical
Abortion in India, held in March 2003 in New Delhi, consensus emerged
that the abortion pill should be introduced in phases in India's family
welfare programme. But, as women's groups have argued persuasively in
the case of hazardous contraceptives, the public health care system must
provide full information and counseling services to all potential users.
Available options should be discussed in pre-abortion counseling, with
the pros and cons for each.
At present, however, medical abortion is being provided in India largely
by the private sector. Dr Sharad D. Iyengar, of Action for Research and
Training for Health, Udaipur, strongly recommends the introduction of
medical abortion as a primary health service so that safe abortion is
more widely accessible to women, and rampant misuse of the abortion pill
is prevented, particularly in remote rural areas.
A study of availability of medical abortion pills in Bihar and Jharkhand
(Bela Ganatra, V. Manning and S.P. Pallipamulla, 2005) noted that
Mifepristone and Misoprostol were widely available at chemist shops.
Though supposed to be provided against doctor's prescriptions, chemists
frequently handed the pills to customers without prescription. In this
area, over 50 per cent customers were men - taking the pill presumably
for their wives or girl friends. Since Misoprostol is much cheaper -
less than Rs 20 (US$1=Rs 39.50) for a pill - there is more demand for
it, and it is being widely used as a home-based abortifacient.
Mifepristone is priced at approximately Rs 100 a pill, so only a
higher-income segment buys it. Only one per cent of the primary health
centers in the area provided abortion services.
Today, pharmaceutical companies, including Zydus, Cadila, Cipla and Sun
Pharma are producing and aggressively marketing the drug in India. A
recent report from Hyderabad reveals a drastic decline in MTPs (Medical
Termination of Pregnancy or legal abortion) in hospitals, attributable
to the ready availability of "the abortion pill, Mifepristone, sales of
which have doubled during the last two years" ('Times of India', 2007).
Public health specialist Dr S.C. Kabra, Indian Institute of Health
Management and Research, Jaipur, sharply criticizes the unregulated
availability of the drugs, as "marketing murder". He notes that
promotional literature by pharmaceutical companies says the drugs are to
be distributed for abortion at home, which is contrary to provisions of
the Medical Termination of Pregnancy Act, 1971; and they are being
distributed by qualified and unqualified practitioners.
It seems that the abortion pill is only the tip of the iceberg. At stake
are many contentious and difficult issues, such as a dysfunctional
public health system, unethical pharmaceutical promotional practices,
lack of independent regulatory mechanisms, limited access to emergency
services - and underlying it all, patriarchal taboos and the sheer
desperation of many women seeking abortion.
While the health system must prevent sex-selective abortion, it must
meet the challenge of making safe and widely accessible abortion
services available to all women. Thus, many believe that the abortion
pill should be introduced judiciously into the family welfare programme
- not as another strategy for population control, but as a tool for
empowering women, and allowing them to lead more joyful, more
responsible lives.
Boloji.com is owned and managed by
Boloji Media Inc Privacy Policy |
Disclaimer No part of this Internet site may
be reproduced without prior written permission of the copyright holder.
