Misoprostol use in Latin America: The experience of Brazil
In Brazil, abortion is illegal except to save the life of the woman or when the pregnancy was the result of rape and incest. In 1986, misoprostol was introduced in Brazil for the prevention of non-steroidal anti-inflammatory drug-induced gastric ulcers. By the early 1990s, the abortifacient properties of misoprostol were well known in Brazil and physicians, pharmacists, and women themselves spread information about misoprostol. Through the use of misoprostol, women were able to self-induce abortions. Women were also able to provoke miscarriages and subsequently present at public health facilities for legal post-abortion care.
The misoprostol experience in Brazil sparked renewed debate about the legal status of abortion and inspired programmatic efforts across the globe to expand access to misoprostol. Although the misoprostol-only regimen is not as effective as when misoprostol is used in conjunction with either mifepristone or methotrexate, the single abortifacient regimen is much safer than many of the methods of self-induction used in legally restricted settings (such as vaginal douching with caustic agents, the use of sharp sticks, or hard massage). Misoprostol alone is also more effective at terminating an early pregnancy than many of the non-efficacious "traditional" methods of abortion that women in legally restrictive settings often employ. Evidence from Brazil has demonstrated that misoprostol offers women a safer option for inducing abortion in legally restrictive settings and that non-clinic use of misoprostol use can reduce both maternal morbidity and maternal mortality at the population level.
Reference: Barbosa R, Arilha M. The Brazilian experience with Cytotec. Studies in Family Planning. 1993; 24(4): 236-240.
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