Misoprostol use in Latin America: The experience of Brazil

In Brazil, abortion is illegal except in cases of rape and incest or to save the life of the woman. In 1986, misoprostol was introduced in Brazil for the prevention of NSAID-induced gastric ulcers. By the early 1990s, the abortifacient properties of misoprostol were well known in Brazil and physicians, pharmacists, and women themselves spread information about misoprostol. Through the use of misoprostol, women were able to self-induce abortions. Women were also able to provoke miscarriages and subsequently gain admittance to public health facilities and access to legal post-abortion care.

The misoprostol experience in Brazil has sparked renewed debate about the legal status of abortion. Although the misoprostol-only regimen is not as effective as when misoprostol is used in conjunction with either mifepristone or misoprostol, the single abortifacient regimen is much safer than many of the methods of self-induction used in legally restricted settings (such as vaginal douching with caustic agents or the use of sharp sticks or hard massage). Misoprostol alone is also more effective at terminating an early pregnancy than many of the non-efficacious "traditional" methods of abortion that women in legally restrictive settings often employ. Evidence from Brazil has demonstrated that misoprostol offers women a safer option for inducing abortion in legally restrictive settings and that non-clinic use of misoprostol use can reduce both maternal morbidity and maternal mortality at the population level.

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