In the US, misoprostol -- also known by its brand name Cytotec -- is a prescription drug approved by the FDA as one of two medications employed in tandem to induce non-surgical, "RU-486"-style abortions. The FDA has never approved misoprostol for solo use for abortions. But in many countries where abortion is banned, the drug is sold without prescription, and millions of women have taken it to end their pregnancies. Simultaneously, many women from these countries have immigrated to the US. During the past decade, speculation has spread about whether they are commonly using misoprostol here to self-induce abortions. Anecdotes abound, including many in New York City, but public health data has been non-existent.
Two reproductive health advocacy groups, Cambridge, Mass.-based Ibis Reproductive Health and New York City-based Gynuity Health Projects decided recently to do some research. These groups and others for years have been teaching how to improve the use of misoprostol in areas where safe, effective abortion is inaccessible. None of the organizations recommend misoprostol abortions when better ones are available. But where they aren't, said Gynuity's president, Dr. Beverly Winikoff, misoprostol is an excellent alternative. Several medical studies show that when taken during the first two months of pregnancy, the drug is safe and effective in 85 to 90 percent of cases. Dr. Daniel Grossman, an OBGYN and senior associate at Ibis, noted that in Brazil and some other Latin American countries, underground misoprostol use is credited with helping to dramatically decrease the abortion injury and death rate among women. In the 10 to 15 percent of cases when misoprostol is taken according to protocol and provokes a miscarriage but doesn't finish it, the woman must immediately seek medical help to complete it. Most problems arise when women take the drug much later in pregnancy, in inappropriate doses, or without quickly seeking medical follow-up for complications.
But many such problems could be prevented by doing "harm reduction" education about misoprostol in communities who are already using it, Grossman and Winikoff argue. Such efforts often go on under the public radar, because of fears about anti-abortion political backlash. To explore whether education programs could be appropriate in the US, Gynuity and Ibis in 2007 quietly started surveying hundreds of low-income Latinas visiting reproductive health clinics in New York, Boston, and San Francisco. The women were asked if they had ever tried to abort themselves in this country.
So what did the study find? Far less misoprostol use than expected, it turns out. Data analysis isn't finished yet and the study won't be published until March. But Grossman said that 1,200 women were surveyed, and at most, only 17 reported using misoprostol at all, let alone in the US. "You absolutely cannot use this study to generalize beyond the groups we studied," he warned. "But the vast majority of the women we talked to went to medical facilities, like Planned Parenthood, to get their abortions. Misoprostol use was not common."
But the Times tells a different story. It says the study finds that in Latina immigrant enclaves like Upper Manhattan, misoprostol is "frequently employed ...despite the widespread availability of safe, legal and inexpensive abortions in clinics and hospitals."
When Times reporter Jennifer Lee contacted the Ibis and Gynuity researchers in December, they could not understand why the Times was doing a news story. We said, ‘There's no news now about misoprostol,'" said Winikoff. "We told her, ‘Maybe there will be if you wait for the study.'" Their fears about premature use of their research were well founded. Lee's editor at the Times, Jodi Rudoren, told RH Reality Check that when Lee talked to her about the study to make a case for an article, she gave an estimated figure for women reporting misoprostol use that far surpassed what the researchers say is correct.
And the Times article hammers misoprostol's dangers, while completely ignoring all the research supporting its potential for relatively safe and effective DIY use. "We told her about that data and our education efforts," Grossman said. Both topics have been covered in other publications in recent years.
The Times article also states -- wrongly -- that self-induced abortions in New York are "illicit," and women do them "illegally." In fact, according to the Guttmacher Institute, 38 states outlaw self-abortion, in laws which often track repressive statutes left over from pre-Roe v. Wade days. But New York isn't one of them -- women there can legally self abort early pregnancies if they want to.
Jessica Gonzalez-Rojas, director of policy and advocacy at New York-based National Latina Institute for Reproductive Health, also was interviewed for the Times story, and she is disturbed by the resulting article. "We dispute the Times' implication that accessing clinics is very easy," she said. "There's the idea among undocumented women that they'll be deported if they go to a clinic, and the Times is wrong about the price of an abortion being cheap for many women."
After the Times piece came out, the national media followed with articles saying that misoprostol use among US Latinas is common, increasing, risky and illegal. As a result, Gonzalez-Rojas said, "there could be legislative action" to further outlaw or crack down on self-induced abortions, "including to criminalize women's use of misoprostol" in the name of protecting them. "We do have concerns."
Dr. Anne Davis, an OBGYN and medical director of New York City-based Physicians for Reproductive Health and Choice, has more fundamental objections. An OBGYN with a practice in Upper Manhattan that includes many low-income, Latina patients, Davis said she felt the Times article "was trying to do a bit of an ‘us versus them' thing," implying that poor, immigrant women have completely different attitudes than Times readers do. "There are plenty of people in Upper Manhattan who are having abortions by accessing the system; they are the overwhelming majority of the community," she said. "Misoprostol is a complex subject. I have seen many women who've used it. And I have seen serious complications. But misoprostol is absolutely appropriate for abortion if there's no other option. The problem is, there is a medical discussion and a sociological discussion about what's right for women." When either conversation intrudes on the other without careful research, thought, and language, David says, needless controversy results. The message from any discussion of misoprostol, she says, is that "We need to do better for women and make sure all of them get good reproductive medical care as soon as they need it. That's the most important thing."
]]>The most recent instance of this is Annie Murphy Paul's "The First Ache," in last Sunday's Magazine. "When does the experience of pain begin?" the subtitle asks. "Anti-abortion activists aren't the only ones to argue that it may be in the womb."
Paul's article, which runs over 5,000 words, begins with a doctor in Arkansas claiming that fetuses as immature as 20 weeks after gestation suffer agonies when prodded and cut during, say, prenatal surgery. And--the point of the piece--when they're aborted.
But then other doctors start discussing the Arkansas physician's claim, and their opinions are all over the map. One insists that fetuses feel no pain until at least 29 weeks. Another pushes the pain date all the way forward to 18 weeks. Someone else says that even born babies can't feel pain until they're one year old. Clearly, there's no consensus on the issue. But the lack of agreement is lost amid the article's looming intimation that women who end their pregnancies are hurting their fetuses. Paul never specifies that the vast majority of abortions--more than 96 percent--are performed before 18 weeks' gestation, the earliest date being claimed for the beginning of fetal pain. Nor does she mention that American women are getting abortions earlier and earlier in their pregnancies: The rate occurring in the first eight weeks has increased sharply in recent years, with many now done in the sixth week of pregnancy or earlier. Without these statistics, the article's main effect is to make female readers feel guilty and confused about abortion.
Paul's is not the only problem piece to run in the Sunday Magazine. Another, by Slate senior editor Emily Bazelon, appeared last January and looked at "post-abortion syndrome" (PAS). A takeoff on PTSD (post-traumatic stress disorder), PAS is not recognized by the psychiatric or psychotherapy establishment because there's no scientific evidence it exists. But moral conservatives out to overturn Roe v. Wade have popularized the purported malady among women who've had abortions. And last year, the Supreme Court cited affidavits submitted by people claiming they've suffered from PAS. The court said the risk to women of contracting the risk of "severe depression and loss of esteem" was one reason to ban "dilation and extraction"--better known as "partial birth" abortion. If for no other reason than this politicking, PAS is well worth exploring.
Problem is, Bazelon skips lightly over politics, focusing instead on fuzzy profiles of self-described PAS sufferers. One is Rhonda Arias, an evangelical minister who runs PAS-support groups in Texas women's prisons. Bazelon follows Arias as she holds forth in one facility, reading from the New Testament, playing gospel music, and handing dolls to inmates who weep as they mourn their aborted offspring. Then Arias asks these prisoners to send her testimonies about their PAS to her so she can submit them to places like the Supreme Court. Read on...
]]>Read the rest of Debbie Nathan's discussion of abortion politics at the New York Times here, on The New Republic's site.