Commercial availability of misoprostol and induced abortion in Brazil

In Brazil, abortion is only permitted to save the woman's life or in cases of rape. The principal effect of legal restrictions is not to make induced abortion practice less prevalent but to force poor women to resort to abortions performed under unhygienic conditions or attempt self-induced abortion. Within this context, misoprostol, a synthetic analogue of prostaglandin El, was introduced in the country in 1986. Purchased over the counter in pharmacies, misoprostol has became a popular abortifacient method among Brazilian women. By 1990, about 70% of women hospitalized with abortion-related diagnoses reported use of the drug. In 1991, the Ministry of Health restricted the sale of misoprostol, and in some states its use was totally banned. While the proportion of abortions induced with misoprostol has decreased, the drug continues to be sold on the black market at an inflated value. Research indicates that women have acquired more experience with the drug over time, resulting in lower doses and more effective administration. Several studies show that the rate and severity of complications are significantly less among women who used misoprostol compared with women who used invasive methods. Research also suggests that about half of the women have complete abortion with misoprostol, but seek medical care as soon as they have vaginal bleeding. The experience of Brazilian women with misoprostol is an example of how women when faced with unwanted pregnancy will resort to illegal abortion whatever the costs are to their health. (C) 1998 International Federation of Gynecology and Obstetrics.