Abstract
Abortion is legally restricted in most of Latin America where 95% of the 4.4 million abortions performed annually are unsafe.Medical abortion (MA) refers to the use of a drug or a combination of drugs to terminate pregnancy. Mifepristone followed by misoprostol is the most effective and recommended regime. In settings where mifepristone is not available, misoprostol alone is used.Medical abortion has radically changed abortion practices worldwide, and particularly in legally restricted contexts. In Latin America women have been using misoprostol for self-induced home abortions for over two decades.This article summarizes the findings of a literature review on women’s experiences with medical abortion in Latin American countries where voluntary abortion is illegal.Women’s personal experiences with medical abortion are diverse and vary according to context, age, reproductive history, social and educational level, knowledge about medical abortion, and the physical, emotional, and social circumstances linked to the pregnancy. But most importantly, experiences are determined by whether or not women have the chance to access: 1) a medically supervised abortion in a clandestine clinic or 2) complete and accurate information on medical abortion. Other key factors are access to economic resources and emotional support.Women value the safety and effectiveness of MA as well as the privacy that it allows and the possibility of having their partner, a friend or a person of their choice nearby during the process. Women perceive MA as less painful, easier, safer, more practical, less expensive, more natural and less traumatic than other abortion methods. The fact that it is self-induced and that it avoids surgery are also pointed out as advantages. Main disadvantages identified by women are that MA is painful and takes time to complete. Other negatively evaluated aspects have to do with side effects, prolonged bleeding, the possibility that it might not be effective, and the fact that some women eventually need to seek medical care at a hospital where they might be sanctioned for having an abortion and even reported to the police.
Highlights
28% of countries –most of them in the developed world– permit abortion upon request.a Unsafe abortion and related mortality are both highest in countries with narrow grounds for legal abortion
Women living in vulnerable social conditions who cannot afford safe clandestine abortions often turn to risky methods like the insertion of foreign bodies into the uterus, drinking toxic solutions, or procedures performed by unskilled providers [3,4]
Few studies focus exclusively on medical abortion, while the rest address medical abortion within a wide variety of issues related to the abortion event such as reasons for seeking an abortion, the decision making process, or attitudes towards abortion and include women who used medical abortion as well as women who resorted to other means of pregnancy termination
Summary
28% of countries –most of them in the developed world– permit abortion upon request.a Unsafe abortion and related mortality are both highest in countries with narrow grounds for legal abortion. An estimated 21.6 million unsafe abortions took place worldwide in 2008, almost all in developing countries, resulting in 47,000 maternal deaths and millions of women suffering injury, illness and lifelong disability [1]. The World Health Organization (WHO) estimates that in 2008, 12% of all maternal deaths in the region (1,100 in total) were due to unsafe abortion and about one million women were hospitalized for treatment of complications from unsafe abortion [1,2]. Women living in vulnerable social conditions who cannot afford safe clandestine abortions often turn to risky methods like the insertion of foreign bodies into the uterus, drinking toxic solutions, or procedures performed by unskilled providers [3,4]. Fear of ill treatment and legal reprisals might prevent women from seeking prompt medical care after an abortion [1,6]
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