Misoprostol: A Catalyst for Revolution?

An optimistic op-ed published by Nicholas Kristof this weekend in the New York Times hypothesized that the medication misoprotol will revolutionize abortion access around the world, especially in developing countries, where five-sixths of abortions occur and “up to 70,000 women die a year from complications.”  Kristof claims that the drug, due to its use for other medical reasons, including treating stomach ulcers and stopping postpartum hemorrhages,will be very difficult for governments to ban.

In medical abortion procedures, misoprostol is most often paired with mifepristone (formerly known as RU-486) to end a pregnancy. This combination has a 95% success rate in aborting early pregnancies, and researchers are finding that using only misoprostol has an 80-85% percent success rate, which, as one doctor noted, is still better than the unsafe alternatives that women often try to end their unwanted pregnancies.  And while mifepristone is banned in many countries worldwide (on the African continent, only South Africa and Tunisia have approved it), misoprostol is commonly found throughout the world and can be purchased over the Internet from Indian pharmaceutical companies that mass-produce both mifepristone and misoprostol.  Kristof’s confidence in the pill’s growing influence is apparent:

[L]ast year the World Health Organization expanded [misoprostol’s] uses as an “essential medicine” to include treatment of miscarriages and incomplete abortions.

Brazil and some other countries have tried to tighten access to misoprostol because of its use for abortion. But curbing access to misoprostol would mean that more women would die of hemorrhages.

As word spreads among women worldwide about what a few pills can do, it’s hard to see how politicians can stop this gynecological revolution.

Kristof’s belief in governments’ inability to ban distribution of misoprostol because of its other uses is optimistic. While we wholeheartedly support greater access to abortion worldwide, we need only look at how funding for stem cell research has been effectively banned for the past decade because of anti-choice crusaders bent on stalling medical breakthroughs because of their opposition to abortion rights.

And Kristof’s belief that law enforcement would ignore the drug’s use to end pregnancies where abortion is illegal isn’t completely supported by women’s experiences. Women’s Health News covered a New York Times magazine article in 2006 which reported that in El Salvador, a country with a total abortion ban even in cases of rape, incest or life endangerment, women who were clandestinely using misoprostol for medical abortion have been subjected to police investigations in which forced pelvic/vaginal examinations took place.  In cases of “failed illegal abortions where the doctors have to perform a hysterectomy… the uterus is sent to the Forensic Institute, where the government’s doctors analyze it and retain custody of her uterus as evidence against her.”

Is misoprostol a pill that will revolutionize abortion?  Our hopes lie with Kristof’s optimistic idea of a quiet revolution in abortion access, but the reality might not live up to it.

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