A report in Monday's New York Times, discussing the "off-label" use of misoprostol to end an unwanted pregnancy, has echoes of Captain Renault's claim to be "shocked, shocked to find gambling [at Rick's]." Since the beginning of time, we know that women who feel trapped - for whatever reason - by an unwanted pregnancy will take steps to end that pregnancy. It doesn't matter if it's legal or not. It doesn't matter if it's safe or not. To some women, carrying the pregnancy to term is unbearable (pardon the pun).
As the article points out, women in the US have other, more effective methods for early abortion. But should we really be surprised that some women will opt for do-it-yourself medicine particularly in this climate when health care access is out of reach for ever more Americans and when abortion itself is so stigmatized? For some women, going to a clinic, interacting with protestors and staff can be an alienating or even traumatizing experience. Keeping the experience to oneself or a close friend or family member could be a welcome alternative. Using a medication that explicitly warns against use by pregnant women may correctly be understood as a way to make something happen.
The problem, as Matthew Herper at Forbes.com notes, is that our regulatory structure lacks any incentive for makers of generic drugs to develop new indications - particularly an indication that involves use by pregnant women. As a result, patients and providers are left to improvise. Fortunately, there are well conducted studies which show misoprostol alone is about 80% effective in ending an unwanted pregnancy up to 9 weeks and does not involve more risk than other methods of early abortion. Knowing that some women will take matters into their own hands, a group of public health experts and advocates developed "Instructions for Use: Abortion Induction with Misoprostol in Pregnancies up to 9 Weeks LMP". Let's face it, sometimes its better to refer to the manual.
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