In Colombia, Brazil and the Philippines, the drug is readily available on the black market. An informal survey by New Scientist has also revealed that clandestine abortions with the drug are taking place in the Dominican Republic, Argentina, Spain, Nigeria, South Africa and Indonesia.
In Britain and the US, doctors prescribing the abortion drug RU486 also give misoprostol to induce contractions, although it's not licensed for this purpose (New Scientist, 28 October 2000, p 13). The combination is highly effective. But in countries where abortion is illegal, women are taking misoprostol on its own to induce abortions.
"It's really the poor person's method," says Susheela Singh of the Alan Guttmacher Institute in New York, who has written extensively about clandestine abortion practices in Latin America. The drug is very cheap-as little as 35 US cents-and is often available over the counter.
But taking misoprostol on its own only induces abortions about 40 per cent of the time, so many babies are born after failed abortion attempts. Several studies in Brazil, where up to 75 per cent of clandestine abortions involve misoprostol, suggest the drug causes birth defects such as fused joints, growth retardation and a condition known as Mšbius syndrome, which is characterised by paralysis of the face.
One recent study found that out of 93 children with defects associated with Mšbius syndrome, 34 per cent of those infants had been exposed to misoprostol, compared with just 4.3 per cent of the 279 infants in a control group. Another revealed that 49 per cent of infants born with Mšbius at seven hospitals in Brazil had been exposed to misoprostol, whereas only 3 per cent of 96 infants born with neural tube defects had been exposed to the drug.
While such findings clearly suggest a link between misoprostol and certain congenital defects, the real risk might never be known because it would be unethical to do the necessary studies. "I think [these results] are real. Statistically they are highly significant," says Fernando Vargas of the University of Rio de Janeiro, who took part in both studies. Because the drug is used secretly, it is hard to find out how many birth defects might be caused by it, Vargas adds.
But even critics of the drug's clandestine use recognise that, for women, attempting abortion with misoprostol is less dangerous than other methods, such as injecting saline. Misoprostol can cause bleeding, but this often allows women to enter the health system legally. And it doesn't result in the kind of complications caused by other methods.
In the US, misoprostol is controversial not just because of its use in abortions but because it is widely used to induce labour. The practice has come under scrutiny recently because several cases of uterine ruptures and deaths of babies and mothers have prompted lawsuits.
Author: Sylvia Pagan Westphal, Boston
More at: American Journal of Medical Genetics (vol 95, p 302)
New Scientist issue: 1 September 2001
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