The little pill that could

Misoprostol. It’s not exactly a household name as far as drugs are concerned; however, it has the potential to improve — and even save — thousands of women’s lives in Kenya.

This medication is one of a number of drugs that can be used to induce abortion, in a procedure that has come to be known as ”medical abortion”, or ”abortion by pill”. It provides a cheaper alternative to surgical termination of pregnancy, results in fewer complications if administered correctly — and can also be used to stop haemorrhaging after delivery.

Small wonder, then, that the Kenya Obstetrical and Gynaecological Society (Kogs) is leading a campaign to have misoprostol registered for gynaecological treatment — including that related to abortion (at present, the drug can only be used as an anti-ulcer treatment).

The near-total ban on abortions in this East African country means that Kogs is treading a fine line with the campaign, however.

One person might see it as a legitimate bid to improve women’s health; another as an attempt to make illegal abortions easier, through lifting the spectre of a back-street termination conducted under unsanitary conditions that may lead to a woman’s death.

A report issued earlier this month in Ethiopia at a conference on unsafe abortion makes the point succinctly: ”Misoprostol is inexpensive, simple to administer, easy to store and is therefore particularly appealing to providers in developing countries and to women seeking covert abortions.”

Titled Preventing Unsafe Abortion and Its Consequences, the study was produced by the Guttmacher Institute, a non-profit based in the United States that conducts sexual and reproductive health research.

Perhaps few anti-abortionists in Kenya would believe that misoprostol will only be used for legal abortion, conducted in instances where pregnancy puts a woman’s life at risk.

Joachim Osur, assistant programmes director at the Family Planning Association of Kenya, an NGO, is aware of these concerns. But, he denies that increasing the legal uses of misoprostol will encourage illegal terminations.

”People abort regardless of whether the drug is available or not, regardless of whether abortion is legal or illegal,” he says. ”All the drug will be doing will be to make abortion safe, not encourage it.”

Some doctors have already taken the law into their own hands — discreetly.

”We know that there are people using it [for gynaecological purposes]. But, it is done under the carpet since, firstly, it is not registered for that use — and secondly, because abortion is an offence,” says Osur.

However, doctors who use misoprostol illegally face multiple risks, he warns: ”If … a patient develops complications, the doctor will be charged for two offences; abortion, and administering an illegal drug.”

About 300 000 abortions occur in Kenya every year, according to a 2004 report titled A National Assessment of the Magnitude and Consequences of Unsafe Abortion in Kenya. An estimated 20 000 women are admitted with abortion-related complications to public hospitals alone.

The study was conducted by the Kenya Medical Association, the local chapter of the Federation of Women Lawyers, health ministry officials and Ipas (an international NGO that lobbies for women’s sexual and reproductive rights).

According to the World Health Organisation, 4,2-million unsafe abortions occur in Africa every year, resulting in about 30 000 deaths.

Misoprostol tablets can be swallowed or inserted in the vagina. If administered too early or too late in a pregnancy, the drug may not lead to a successful abortion. However, success rates of up to 95% have been recorded when misoprostol is given under medical supervision at the right time: ideally while a woman is between seven and nine weeks pregnant.

Misoprostol and mifepristone, another drug, are the treatments most commonly used for medical abortion. No drugs that induce terminations have ever been registered for this purpose in Kenya.

Pending a government decision on broadening the legal uses of misoprostol — and despite the risk of a backlash from opponents of abortion — Kogs has already started providing information about the drug to medical professionals.

”It is good for health-care providers to know what the drug is for and how to use it,” says Joseph Karanja, a former chairperson of Kogs who now sits on the society’s council. ”There is no law that prohibits professionals from disseminating and sharing information.” — IPS

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Joyce Mulama
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