Misoprostol in women's hands: a harm reduction strategy for unsafe abortion

Abstract

On any given day in Cuernavaca, Cape Town, Quezon City or Calcutta, a woman with an unwanted pregnancy seeks out misoprostol to have an abortion. She does not visit a doctor or clinic but seeks a pill that she has heard can help her end her pregnancy without the risks of more dangerous self-induction methods. Women living in legally restricted settings where they do not have access to high-quality safe services or where stigma, cost or other barriers prevent them from accessing existing services are increasingly using misoprostol to selfinduce abortion instead of using sticks, acid, brute force or unproven herbal remedies. In doing so, they are significantly reducing the harms caused by unsafe abortion. Harm reduction is an evidence-based public health and human rights framework that prioritizes strategies to reduce harm and preserve health in situations where policies and practices prohibit, stigmatize and drive common human activities underground. The best-known application of a harm reduction model is in the field of HIV, where needle exchange programs and safe injection centers have been shown to be highly effective in preventing HIV/sexually transmitted infection. We propose that promoting the use of misoprostol for abortion using a harm reduction approach could dramatically increase access to safer abortions. The principles of harm reduction — neutrality, humanism and pragmatism — present a conceptual framework for making misoprostol information andcareavailable directlytowomen and make the case for why it is imperative that we do so.