Women’s reliance on the black marketplace for access to medication abortions means they might not follow best medical practice. When C., a 24-year-old teacher in Recife, bought misoprostol from a drug dealer last 12 months, she searched Google to work out how one can take it. “Since it was illegal, there was no details about how one can take it or what to take,” she said.
Her search found recommendations to insert the tablets in her vagina, as a physician would if she were in a clinic, but cautioned that traces is perhaps left behind and provides her away if she wound up in hospital; as a substitute, she dissolved them under her tongue, a technique that also works but less quickly.
C., who asked to be identified only her middle initial out of fear of prosecution, bled for weeks after and desired to ask her mother, a gynecologist, for advice. But her mother is an anti-abortion activist. Finally, C. said she thought she had miscarried, and her mother took her to see a colleague who performed a dilation-and-curettage under anesthetic.
“After I was having the curettage, I had to maintain saying again and again to myself, ‘Don’t say anything, you possibly can’t say anything’ — it was torture,” she said. “Despite the fact that I used to be totally sure that I wanted an abortion, I had no doubts, you continue to feel such as you’ve done something incorrect because you possibly can’t speak about it.”
The restriction on misoprostol has complicated regular obstetric care, which uses on the drug for induction of labor, said Dr. Derraik. On the Rio public maternity hospital where she is medical director, a physician must fill out a request in triplicate for the drug, have it signed by Dr. Derraik, take it to the pharmacy where the supervisor must also sign before taking it out of a locked cabinet, after which the physician must administer the drug with a witness, to make sure it is just not diverted for black market sale.
“Not all of those steps are officially required,” Dr. Derraik said. “But hospitals do them due to the extraordinary paranoia across the drug.”