Women’s reliance on the black market for access to medical abortions means they may not follow best medical practices. When C., a 24-year-old teacher in Recife, bought misoprostol from a drug dealer last year, she Googled how to take it. “Because it was illegal, there was no information on how to take it or what to take,” she said.
Her research found recommendations for inserting the tablets into her vagina, as a doctor would if she were in a clinic, but warned that traces could be left behind and betray her if she ended up in hospital; instead, she dissolved them under her tongue, a method that also works but less quickly.
C., who asked to be identified only by her middle initial for fear of prosecution, bled for weeks afterwards and wanted to seek advice from her mother, a gynecologist. But her mother is an anti-abortion activist. Eventually, C. said she thought she had a miscarriage, and her mother took her to see a colleague who performed dilation and curettage under anesthesia.
“When I had the curettage I kept saying to myself, ‘Don’t say anything, you can’t say anything’ – it was torture,” she said. “Even though I was totally sure I wanted an abortion, I had no doubts, you still feel like you did something wrong because you can’t talk about it.”
The restriction on misoprostol has complicated regular obstetric care, which uses the drug for labor induction, Dr. Derraik said. At the public maternity hospital in Rio where she is medical director, a doctor must fill out a request in triplicate for the medicine, have it signed by Dr. Derraik, take it to the pharmacy where the supervisor must also sign before taking it out of the hospital. ‘a locked cupboard, then the doctor must administer the drug with a witness, to ensure that it is not diverted to sale on the black market.
“Not all of these steps are officially required,” Dr. Derraik said. “But hospitals are doing them because of the intense paranoia around drugs.”