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Article Excerpt
Abstract: In Latin America, where abortion is almost universally legally restricted, medical abortion, especially with misoprostol alone, is increasingly being used, often with the tablets obtained from a pharmacy. We carried out in-depth interviews with 49 women who had had a medical abortion under clinical supervision in rural and urban settings in Mexico, Colombia, Ecuador and Peru, who were recruited through clinicians providing abortions. The women often chose medical abortion to avoid a surgical abortion; they thought medical abortion was less painful, easier or simpler, safer or less risky. They commonly described it as a natural process of regulating their period. The fact that it was less expensive also influenced their decision. Some, who experienced a lot of pain, heavy bleeding or a failed procedure requiring surgical back-up, tended to be more negative about it. Regardless of legal restrictions, medical abortion was being provided safely in these settings and women found the method acceptable. Where feasible, it should be made available but cost should not have to be women's primary reason for choosing it. Psychosocial support during abortion is critical, especially for those who are more vulnerable because they see abortion as a sin, who are young or poor, who have limited knowledge about their bodies, whose partners are not supportive or who became pregnant through sexual violence.
Keywords: medical abortion, women's perspectives, Colombia, Ecuador, Mexico, Peru, Latin America
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Resume
En Amerique latine, ou l'acces a l'avortement est presque partout restreint par la loi, l'avortement medicamenteux, particulierement avec le seul misoprostol, est de plus en plus utilise, souvent avec des comprimes obtenus dans une pharmacie. Nous avons interroge 49 femmes ayant subi un avortement medicamenteux sous surveillance clinique dans des environnements ruraux et urbains au Mexique, en Colombie, en Equateur et au Perou, sur le conseil de cliniciens pratiquant les avortements. Les femmes avaient souvent choisi l'avortement medicamenteux pour eviter l'avortement chirurgical ; elles pensaient que cette methode etait moins douloureuse, plus facile, plus sure ou moins risquee. Elles la decrivaient comme un processus naturel de regulation des menstruations. Son moindre cout avait aussi influence leur decision. Certaines, qui avaient eu de fortes douleurs, des saignements prolonges ou qui avaient du completer l'avortement avec une intervention chirurgicale, etaient plus negatives. Sans se soucier de restrictions legales, l'avortement medicamenteux etait pratique sans risque et ces conditions, les femmes pensaient que la methode etait acceptable. Quand c'est possible, il devrait etre propose, mais le cout he devrait pas etre la premiere raison du choix des femmes. Le soutien psychosocial est essentiel, particulierement pour celles qui sont plus vulnerables parce qu'elles considerent l'avortement comme un peche, qui sontjeunes ou pauvres, connaissent mal leur corps, dont les partenaires he les epaulent pas ou qui sont enceintes par suite de violences sexuelles.
Resumen
En Latinoamerica, donde el aborto es restringido casi universalmente por la ley, el aborto con medicamentos, especialmente con misoprostol solo, se utiliza cada vez mas, a menudo con comprimidos obtenidos de una farmacia. Realizamos entrevistas a profundidad con 49 mujeres que habian tenido un aborto con medicamentos bajo supervision clinica en zonas rurales y urbanas de Mexico, Colombia, Ecuador y Peru, quienes fueron reclutadas por profesionales clinicos que prestaban servicios de aborto. A fin de evitar un aborto quirurgico, muchas mujeres eligieron el aborto con medicamentos, pues lo consideraron menos doloroso, mas facil o sencillo, mas seguro o menos arriesgado. Comunmente lo describieron como un proceso natural de regulacion menstrual. El hecho de que era menos costoso tambien influyo en su decision. Algunas, que experimentaron mucho dolor, sangrado abundante o un procedimiento fallido, que requirio respaldo quirurgico, eran mas negativas al respecto. Sin considerar restricciones de ley, el aborto con medicamentos estaba siendo efectuado de manera segura y en tales circunstancias las mujeres lo encontraron aceptable. Donde sea factible, debe hacerse disponible, pero el costo no debe ser la razon principal para su eleccion. El apoyo psicosocial durante el aborto es fundamental, especialmente para las mujeres que son mas vulnerables porque ven al aborto como un pecado, son jovenes o pobres, tienen poco conocimiento de su cuerpo, sus parejas no las apoyan, o quedaron embarazadas a causa de violencia sexual.
UNSAFE abortion remains a serious public health problem in Latin America. Although abortion is almost universally legally restricted, in each of the countries abortion services are widely available, especially in urban areas, ranging from safe (and generally more expensive) to unsafe, with rural and poor women disproportionately affected. (1) The rate of unsafe abortions is about 29 per 1000 women of reproductive age. (2) In Ecuador, Peru, Mexico and Colombia, induced abortion is defined as a crime in the penal code, with few exceptions. (3) Estimates for 1995-2000 indicate that in Ecuador 18% of maternal deaths are due to unsafe abortion, in Peru 16%, Mexico 23% and Colombia 28%. (4) Little effort has been made to improve access to safe abortion services in these countries, but post-abortion care programmes to treat abortion complications have been promoted throughout the region. (5)
Interest in the use of medical abortion has been growing during the past decade throughout Latin America, * using mainly misoprostol alone. In some places, methotrexate plus misoprostol is used, mainly under clinical supervision. Compared to other techniques used to induce abortions clandestinely, medical methods appear to be safer and associated with fewer...
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