NY Times Botches Abortion Conversation

Several prominent women's health advocates are dismayed by a recent New York Times article about do-it-yourself abortions using the drug misoprostol. The Times piece, published January 4, mischaracterized a study about the drug, and researchers say the piece is sensationalist, implying that lots of New York City Latinas are seriously endangering their health and breaking the law. Some activists now worry that the Times article could muffle a more nuanced discussion about access to reproductive health care for immigrant women that transcends the phenomenon of DIY misprostol abortions. 

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."