about ipas
newsroom
what we do
where we work
products
publications
contact

January 3, 2006
Recent research in four Latin American countries found that medication abortion is acceptable to a wide array of women, with some differences according to age, place of residence and beliefs about abortion.

Though most Latin American countries severely restrict access to safe abortion, an increasing number of women in the region are resorting to the drug misoprostol to terminate unwanted pregnancies. Yet many of those women may be using the drug without medical supervision or proper instructions.

Two new studies published in the November 2005 issue of the London-based Reproductive Health Matters journal explore crucial issues surrounding the use of misoprostol: how to get instructions to women so that the drug may be taken safely, and how women who have used this form of medication abortion describe their experiences.

Dr. Janie Benson, Ipas’s Vice President of Research and Evaluation, said: “This research highlights women’s experiences in coping with unintended pregnancy in Latin America. The findings underscore women’s need for accurate information about misoprostol and the important role that medication abortion has in enhancing women’s access to safe abortion.”

Originally approved by the U.S. Food and Drug Administration and other regulatory agencies to prevent and treat gastric ulcers, misoprostol also causes uterine contractions and cervical softening.

Those effects make the drug, alone or in combination with mifepristone, an effective way to safely induce abortion. The combined regimen of mifepristone and misoprostol is on the World Health Organization essential drugs list for safe abortion care, and it is used widely in United States and Europe.

But off-label use of misoprostol in Latin America and social climates that suppress open dialogue about abortion make it difficult for women to learn how to take the drug safely, how it works and how to recognize when the abortion is complete or when it’s necessary to seek emergency care.

In “Reaching Women with Instructions on Misoprostol Use in a Latin American Country,” six researchers (including Ipas Senior Research Associate Dr. Deborah Billings) asked urban and rural women, some of whom had undergone safe abortions; physicians and midwives; pharmacists and reproductive-health activists in an unidentified nation how women should get information about medication abortion.

Across the spectrum, study participants agreed that doctors were ideally the most appropriate source for misoprostol information because of their medical training. Midwives were considered for women in rural areas but only if provided with additional training.

Yet study participants recognized the conditions that prevent women from accessing abortion information and physicians in general. While recognizing the physicians’ important roles in providing women with information about misoprostol, many added that anti-choice physicians could withhold that knowledge or that others who don’t admit to providing abortion services might not be reliable sources.

Limiting information to physicians only would severely restrict women’s access to accurate facts about misoprostol use. At the same time, respondents expressed some concern that the information source should have some basic medical background. 

Professional risks associated with providing information about using misoprostol for safe abortion influenced beliefs about what forms the information should take. Overall, verbal instructions, complemented by written instructions in the form of a simple brochure, were viewed as suitable for most women. Verbal instructions alone were seen as insufficient since information could be forgotten or misunderstood, while written instructions potentially jeopardize providers’ safety if their contact information is included.

In the second study, “Women’s Perspectives on Medical Abortion in Mexico, Colombia, Ecuador and Peru: A Qualitative Study,” the authors present results from interviews with 49 women who had undergone medication abortions under the care of a health-care provider. 

Few of the women, with the exception of urban Mexicans, had consistently used any contraceptive method. Yet 15 women said they had some knowledge of medication abortion before visiting a provider.

Women cited a variety of reasons for seeking an abortion: desire not to disrupt life plans, lack of financial resources to raise a child or pregnancy due to sexual violence.

Many preferred medication abortion rather than surgical methods because they thought it was less painful, less risky and simpler. That it was less expensive than a surgical abortion also influenced some women’s decisions. Most women (88 percent) said they would recommend it to a friend.

While the women held generally favorable attitudes about the process, their area of origin or residence as well as previous experiences and beliefs about abortion also played a role in perceptions of how prepared they felt for the abortion and how painful it was.

Most women from Colombia and urban Mexico reported that they felt sufficiently prepared for the abortion. Women from Ecuador and Peru — who were younger, poorer and less likely to have children and supportive partners — reported medication abortion to be more physically uncomfortable than those who had given birth. They were also more likely to feel guilty about having had an abortion or to worry about being judged by others.

The researchers concluded that medication abortion is acceptable to a wide group of women, even in restricted settings. They called for greater attention to pain management for all women — especially for women who have never given birth.

Some women may need additional support as they understand their abortion experience, especially those who believe that abortion is a sin, whose pregnancy is due to rape, whose partners are not supportive, and who have very limited knowledge about their bodies.

Studies co-author Deborah Billings said: “Women throughout Latin America terminate unwanted pregnancies, despite restrictive laws. Medication abortion is an important option that allows women to do so in ways that are safe and effective. More work needs to be done so that women have the information they need to put this option into practice.”

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258