Deyanira González de León, A., Universidad Autónoma Metropolitana Xochimilco, Mexico City, Mexico
Co-authors: Erika Troncoso, María Elena Collado, Raffaela Schiavon (Ipas Mexico)
The use of Internet has increased considerably and has become a common tool to search for information on issues like abortion, especially among young people. Internet is an important source of information about the use of misoprostol as abortifacient and currently there are websites selling the drug (commercially distributed as Cytotec). In this paper we present the results of a study aimed to explore the information about medical abortion (MA) offered through websites selling Cytotec, as well as the most common questions from its users. The final purpose of this study was to obtain evidence that could be used to improve information strategies on the use of misoprostol as abortifacient.
MA is, alongside with manual vacuum aspiration, one of the standard methods recommended by the World Health Organization (WHO) to terminate pregnancies. The practice of MA has increased in many countries over the recent years and has substantially contributed to improving the quality of legal abortion services. The combined use of mifepristone and misoprostol is currently the most effective regimen for early MA and has been included in the complementary List of Essential Medicines of the WHO since 2005. Millions of women worldwide have used this combination of drugs and have found it to be safe and
Mifepristone is not legally available in most countries of the developing world and the use of misoprostol alone has become a safe alternative to provide early MA in places where the drug is available. An optimal regimen for the use of misoprostol alone is still under research, but clinical studies report high efficacy rates –around 85% and more- when applied vaginally or sublingually for pregnancies of 63 days’ gestation or less.Because of legal restrictions on abortion the use of misoprostol alone has gained interest and acceptability among physicians in Latin America. Besides, the drug is increasingly being self-administered by women as an alternative to other dangerous methods. In many countries, misoprostol is available at pharmacies without medical prescription, and in some, such as Brazil and Peru, its use has been associated with less complications and deaths.
In Mexico, abortion laws remain highly restrictive except for Mexico City where abortion was decriminalized in 2007 and is permitted on demand during the first 12 weeks of gestation. Since then, public health services governed by the local Department of Health provide abortions using the WHO recommended methods. In 2008, 39% of all legal pregnancy terminations were done using misoprostol alone.11 On the other hand, the use of misoprostol as abortifacient is common and increasing in Mexico, but as in other Latin American countries both women and pharmacists, and even many physicians, lack of enough information on the safest and most effective doses of the drug, or about what to expect during the process or what to do if it fails.
A search performed in 2008 found seven websites offering misoprostol, out of which three were selected for further analysis: Ayuda Cytotec, Cytotec México, and Soluciones Cytotec. Criteria used for the selection was that these websites had question/answer sections, open not only to buyers but also to all visitors. 20% of all questions and answers registered between January and June 2008 were randomly selected for each one of these websites. The search was done giving a marker to each question and then making a random selection of them using the SPSS. The analysis was performed on 215 cases, which were incorporated into an Excel database. The database included the specific website, questions, dates of questions and answers, and answers from the website. Although the database included information on sex and age of those consulting, as well as weeks of pregnancy and use of misoprostol at the time of the query, these data were not always consistent because of insufficient information at the websites.
The results show that the five most common questions asked by users referred to: how to detect if the abortion was completed (21%); information about the use of misoprostol, including efficacy, risks related to previous abortions, weeks of gestation, and confirmation of pregnancy, among others (17%); routes of administration and dosage (11%); side effects (9.7%); and post-abortion care (7.9%). In addition, 79% of questions were made by women; 41% of those consulting had 9 or less weeks of gestation; and 43% were using misoprostol at the time of the query.
A first conclusion is that the selected websites not only sell misoprostol but also represent a useful source of information about the drug (dosage, gestational limit, side effects). However, these websites do not include accurate information about the evolution of an abortion using misoprostol or what to do in case of failure. This kind of information is only available to those using the question/answer sections and answers from the websites do not always meet the needs of users. Another conclusion is that self-administration of misoprostol without all the necessary information is a common practice among women. Finally, the analysis of the questions made by users demonstrates the need to elaborate documents and other resources that give women complete, accurate and reliable information about MA.