With Pope Benedict reportedly telling a recent convention of Roman Catholic pharmacists to help protect human life from conception until natural death and "avoid collaborating... in the supply of products which have clearly immoral aims, for example abortion or euthanasia", the abortion pill has drawn attention once again. The pill, not authorized in Italy, is available in many European Union countries since the 1980s; in the United States since 2000; and in India since February 2002.
"An abortion pill is definitely a safe and a better option over surgical abortion - provided the pregnancy is less than seven weeks. Any time past seven weeks requires surgical abortion," explains Dr Duru Shah, Consulting Obstetrician and Gynecologist, Mumbai. He adds that post seven weeks, the pill can lead to partial abortion: part of the pregnancy tissue might remain in the uterus. This can cause severe infection, which, if not treated, could lead to cancer.
People often confuse the abortion pill with the morning-after pill. The latter is a contraceptive; one dose of the same is required to be taken within 72 hours of sexual intercourse. The morning-after pill is available over-the-counter, since medical supervision is not considered essential. On the other hand, the abortion pill should be taken only under strict medical supervision as it could result in heavy bleeding.
Ironically, many people imagine the abortion pill to be a kind of magic wand that will accomplish a vanishing-act as regards an unwanted fetus. Such grossly misinformed views are evident in the following submissions to the DoctorNDTV (a popular TV channel's health portal) website: "According to me, morning-after abortion pills should not be freely available at chemist shops because it will encourage prostitution, extra-marital and pre-marital affairs..." says one. However, according to another, "There is nothing of misuse of this medicine in my view. As the desire for sex is ultimate, so when sex cannot be avoided, then there should be surely some safe side... So, this pill should be available freely."
In the wider ethos of misinformation regarding all matters sexual, the abortion pill, in fact, has been misused. At a national experts meeting held at AIIMS (All India Institute of Medical Sciences, New Delhi) in October 2002 to frame guidelines for the abortion pill, Dr. J.V.R. Prasada Rao, then Secretary, Department of Family Welfare, said, "I have got reports that it was available even at 'paan' (betel leaf) shops in Mumbai. Reports of complications and misuse has made a monster out of a safe drug which has forced us to formulate guidelines."
The abortion pill is that it is actually two different drugs, to be taken in combination. The first drug, RU-486 or Mifepristone, is taken after pregnancy has been confirmed. The second drug, Misoprostal, is administered after another 48 hours or so.
However, before any woman takes the abortion pill, high-risk factors must be ruled out. These include anemia (hemoglobin less than 8 gm per cent), cardiovascular disease, chronic adrenal failure, uncontrolled seizure disorder, severe liver, renal or respiratory disease, and a history of taking aspirin, steroids or antidepressants. The pill is also not advisable for HIV+ persons, or for heavy smokers. Caution is to be exercised in patients with fibroid uterus or previous surgery on uterus or cervix.
Clearly, the abortion pill is not an uncomplicated method. There are a lot of dos and don'ts attached. In any case, no abortion method should be considered a regular alternative to contraception. If pregnancy is not wanted, it is best prevented. But since no contraceptive method is foolproof, we do need accessible abortion methods. Women worldwide have won the right to abortion after intense struggle and it is important to protect this right.
Interestingly, at a consortium on National Consensus for Medical Abortion in India, held in March 2003 in New Delhi, consensus emerged that the abortion pill should be introduced in phases in India's family welfare programme. But, as women's groups have argued persuasively in the case of hazardous contraceptives, the public health care system must provide full information and counseling services to all potential users. Available options should be discussed in pre-abortion counseling, with the pros and cons for each.
At present, however, medical abortion is being provided in India largely by the private sector. Dr Sharad D. Iyengar, of Action for Research and Training for Health, Udaipur, strongly recommends the introduction of medical abortion as a primary health service so that safe abortion is more widely accessible to women, and rampant misuse of the abortion pill is prevented, particularly in remote rural areas.
A study of availability of medical abortion pills in Bihar and Jharkhand (Bela Ganatra, V. Manning and S.P. Pallipamulla, 2005) noted that Mifepristone and Misoprostol were widely available at chemist shops. Though supposed to be provided against doctor's prescriptions, chemists frequently handed the pills to customers without prescription. In this area, over 50 per cent customers were men - taking the pill presumably for their wives or girl friends. Since Misoprostol is much cheaper - less than Rs 20 (US$1=Rs 39.50) for a pill - there is more demand for it, and it is being widely used as a home-based abortifacient. Mifepristone is priced at approximately Rs 100 a pill, so only a higher-income segment buys it. Only one per cent of the primary health centers in the area provided abortion services.
Today, pharmaceutical companies, including Zydus, Cadila, Cipla and Sun Pharma are producing and aggressively marketing the drug in India. A recent report from Hyderabad reveals a drastic decline in MTPs (Medical Termination of Pregnancy or legal abortion) in hospitals, attributable to the ready availability of "the abortion pill, Mifepristone, sales of which have doubled during the last two years" ('Times of India', 2007).
Public health specialist Dr S.C. Kabra, Indian Institute of Health Management and Research, Jaipur, sharply criticizes the unregulated availability of the drugs, as "marketing murder". He notes that promotional literature by pharmaceutical companies says the drugs are to be distributed for abortion at home, which is contrary to provisions of the Medical Termination of Pregnancy Act, 1971; and they are being distributed by qualified and unqualified practitioners.
It seems that the abortion pill is only the tip of the iceberg. At stake are many contentious and difficult issues, such as a dysfunctional public health system, unethical pharmaceutical promotional practices, lack of independent regulatory mechanisms, limited access to emergency services - and underlying it all, patriarchal taboos and the sheer desperation of many women seeking abortion.
While the health system must prevent sex-selective abortion, it must meet the challenge of making safe and widely accessible abortion services available to all women. Thus, many believe that the abortion pill should be introduced judiciously into the family welfare programme - not as another strategy for population control, but as a tool for empowering women, and allowing them to lead more joyful, more responsible lives.