College and high school female students are now turning to a drug meant for treating gastric ulcers to induce abortions, but doctors warn that they are in for dire consequences for abusing it. 

Scared about the aftermath of going to a quack on the back-street, the women have turned to the drug as the cheap and best option in procuring abortion. Our survey in various city chemists found out that increasing numbers of young women are demanding for the drug, which is given only on prescription.

“We have had to turn away several women because they lacked a prescription from a doctor to purchase the drug,” says Simon Siele, an attendant at one of the city pharmacy. 

Siele recalls how one woman pleaded for the drug saying she is HIV positive and did not want to carry the pregnancy to term, for fear of giving birth to an HIV positive baby. The pharmacy declined to sell the drug to her without a doctor’s slip. 

But women have become smart, and are able to get the prescription from unscrupulous doctors, a thing pharmacists say is beyond their ability to decipher. 

“Once a client comes with a prescription, we do not question its source or try to find its authenticity, we just sell the medicine,” says an attendant at another pharmacy on Moi Avenue, who identified himself only us Peter. 

Most of those who dispense the drug do so secure in the knowledge that they are giving it to an ulcer patient. And are scarcely aware of other uses the women are putting the drug to. 

In our survey, unqualified medical practitioners operating clinics in city estates were the main culprits issuing women with prescriptions to enable them access the medicine. 

However in other cases, there were pharmacy attendants giving the drug without a prescription in return for an incentive from the buyer. 

The drug, Misoprostol, is indicated by the manufacturers only for prevention and treatment of gastric ulcers and excessive acid production. 

It was expected to intervene in people who have developed ulcers after long-term use of painkillers, until in recent years when women and some scientists realized it could also be used for other purposes. 

The dosage required to induce an abortion goes for less than Sh 1,000, amount to some women is affordable compared to the over Sh 3,000 they spend when they seek the services of qualified doctors or backstreet abortionists. 

Most the gynecologists we talked to did not want to be quoted; fearing people might misconstrue their thoughts as those coming from those who procure abortions. 

But they readily admitted that women are using the drug without the knowledge of its side-effects when abused – used in wrong dosages and at an inappropriate time of the pregnancy. 

“I have attended to three cases with incomplete abortion after they used the drug to induce the foetus release. They were completely ignorant of the dosages and the timing of their pregnancy before using the drug,” said one of the doctors who operated a clinic on Tom Mboya Street. 

In his case, the women were experiencing excessive bleeding, with one of them being severely anaemic. Most of the women are concerned of one thing: to flush out the foetus with very high dosages regardless of the stage at which the pregnancy is in, the doctor adds. 

Gynecologists caution that when the drug is given without the watch-full eye of a medical expert, a woman might not know if she has an incomplete abortion.

These women will only realize something is not right once they start experiencing excessive bleeding, uterine perforation, aneamia, or Pelvic inflammatory disease. 

Billed as one of the most common serious infection among young women affecting the uterus, fallopian tubes or ovaries, Pelvic infection is likely to lead to blocked tubes and future infertility.

Consequences are even more dire for those who take the drug - without a doctor’s observation - when the pregnancy is over four months old.

Any overdose of the drug at this time of the pregnancy will result in excessive contraction and rupture of the uterus. In this case, the only option is uterus removal, an action that makes it impossible for such women to give birth.

An article in the 2004 International Journal of Gynecology and Obstetrics tilted “A consensus regimen for early abortion with misoprostol” by M Philip and others, warns against using misoprostol alone for abortion purposes in pregnancies more that 9 weeks old.

Women who use this drug and experience botched abortions, end up giving birth to infants with high anomalies caused by exposure to the drug, says the article.

“Caution is recommended when administering misoprostol for abortions beyond 9 completed weeks LMP. There is insufficient evidence to recommend a regimen of misoprostol for late first trimester abortion induction,” the article warns.

The anxiety in the scientific community on the misuse of the drug comes at time when unsafe abortion cases are on the rise. Currently in Kenya, abortion cases are said to have doubled from 400 to 800 a day in just under 10 years.

According to the World Health Organization, 4.2 million unsafe abortions occur in Africa every year, resulting in about 30,000 deaths. Majority of these deaths are due to complications of abortion such as excessive bleeding, anemia and other infections.

The women and scientific community realized of the misoprostol’s ability to procure abortion when they learnt it could cause miscarriage when used to treat ulcers in a pregnant woman.

They further came to know how some doctors were using the drug to treat incomplete abortions, meaning the drug is used to flush out the products of conception, which remain in the body after an unsuccessful.

It is also believed the warning by the manufacturer of the drug that it should not be used by pregnant women, for it is likely to induce a miscarriage,  convinced the women about its ability to abort.

Despite the manufacturers warning, researchers have gone a head to study the ability of the drug to manage many reproductive health issues related to women. 

Currently, the drug is used in the preparation of the cervix for surgical procedures or prevention or treatment of postpartum hemorrhage.

A nurse at Kenyatta National Hospital said clinical studies are also underway at the institution to establish the safety and effectiveness of the drug when used to induce labour pains in women with prolonged pregnancies. 

Proponents of abortion have been putting pressure on pharmaceutical industry to manufacture and register the drug as a medical intervention for women’s reproductive health problems such as inducing labour pains.

Dr David C Reardon of Elliot Institute, United States, says these proponents of abortion argue that the right to abort unplanned pregnancies empowers women.

They view unplanned children as the cause of lost education and career opportunities; and abortion as an action enabling women to control their lives, pursue their dreams, and ultimately improve their socio-economic status.

To Dr Reardon, this argument presupposes that the birth of an unplanned child has a negative effect on women's lives and that abortion has a positive, or at least neutral, effect.

Hence, some of these advocates want the drug licensed for safe abortion purposes whenever a woman demands for it.

But this has been vigorously opposed in many African countries, with abortion legally allowed only in certain circumstances.

In Cameroon, Kenya, Sierra Leone, Central Africa Republic, Botswana, Burkina Faso, Caper Verde, Togo, Ethiopia, Zambia, Zimbabwe, and Senegal, just to mention a few, abortion is allowed if it is to save the mothers life. In Sierra Leone and Cameroon, it is permitted if the pregnancy is a result of rape.

While in Togo it is legalized, with a doctor's approval, in cases of rape and incest. Other countries permit abortion in cases of foetus deformation or if the pregnant woman is mentally handicapped

Only in South Africa is a abortion allowed on demand since 1997. In Ethiopia, abortion is legal on demand for 18 year old and below.

Pharmaceutical companies have taken cue to refuse to grant these proponents and the scientific community the request to develop and register the drug for women’s health, including termination of pregnancy or treatment of incomplete abortions.

Much of the pressure being exerted on the pharmaceutical companies follows a raft of research information, which has shown the ulcer drug to work for certain women’s reproductive health problems in the most affordable manner.

According to a study published in the 2005 The New England Journal of Medicine, the drug was used successfully in women who had experienced pregnancy failures - fetal death or incomplete spontaneous abortions.

Of the 491 women who were given misoprostol, 71 percent had complete expulsions of the fetus.

Says the Journal: “Misoprostol therapy as an alternative to surgery appears to be highly acceptable where it has been tested. Using it in an outpatient settings reduces cost of services and does not require sterilized equipment or surgically skilled personnel.”

Studies in Uganda have returned similar verdict, although the dosages of misoprostol used were different.

It is estimated that one in four women will have an early pregnancy failure during her life-time. Likewise, 15 percent of all the pregnancies end in spontaneous miscarriage. This is the group the scientific community wants to be helped with the drug or for the African governments to license it for use for reproductive health purposes.

At the moment, those who experience incomplete abortions either face surgery intervention or Manual Vacuum Aspiration, both legally permitted methods.

An AWC Feature