Even When Abortion Is Illegal, The Market May Sell Pills For Abortion

Sep 23, 2014
Originally published on September 24, 2014 9:22 am

In the central market in San Salvador, you can buy just about anything you want: tomatoes by the wheelbarrow full. Fresh goat's milk straight from the goat. Underwear. Plumbing supplies. Fruit. Hollywood's latest blockbusters burned straight onto a DVD.

And in the back of the market, in a small stall lined with jars of dried herbs, roots and mushrooms, you can buy an abortion.

"I have all types of plants to treat all kinds of diseases," the woman who runs the shop says through a translator. "For example, problems with your liver, your kidneys, stomach problems, nerves, for cancer — for everything."

She says she also has a bitter tea that can take care of an unwanted pregnancy.

Abortion is completely banned in El Salvador and punishable with a prison term of anywhere from two to 50 years in prison. So this woman asks that we not use her name.

Her tea only works, she says, in the first six weeks of pregnancy. If a woman is seeking an abortion later than that, the herbalist arranges to get something far stronger from a local pharmacy: pills used to treat stomach ulcers that are sold generically as misoprostol.

"They come asking for help," the woman says. "The majority of them are minors — young girls who say they were raped by their stepfathers or by people a lot older than they are."

"Sometimes they are being threatened by their stepfathers that if they tell their moms, he's going to kill them or kill the family," she adds.

She says when a girl comes seeking an abortion, it's because her life is in crisis. Often they are crying. They recount tragic tales, she says — tales of rape, abuse, betrayal or misguided love.

Some of the stories may be embellished, but what's clear is that these girls are desperate and willing to do almost anything to get out of their predicament.

The herbalist charges roughly $200 for a course of three pills that would cost less than $5 in a U.S. pharmacy.

This illicit trade in misoprostol has cut the rate of maternal deaths in El Salvador significantly, says Sofia Villalta Delgado, with the Salvadoran Ministry of Health. Before misoprostol, women were regularly turning up at hospitals with major complications from botched abortions.

"When we were students and when we first started in medicine, women were arriving at the hospital totally septic, with infection in their entire abdomen," she says through a translator. "You had to take out the whole uterus."

This has gone down significantly, she adds.

Delgado says the Ministry of Health doesn't endorse the use of misoprostol for abortion. After, all abortion is against the law in El Salvador. But as a public health official, she's sees what she says is a public health benefit from the illicit use of this drug.

In 2000, the Food and Drug Administration approved misoprostol for abortions in the U.S., but only in conjunction with another drug called mifepristone. The combination has come to be known as the "abortion pill." It's also become the most common form of medication abortion in the U.S., Canada, China, India and much of Europe.

Misoprostol on its own isn't as effective as the two-drug method. In a 2010 study of 400 women seeking early medical abortion, 76 percent of those given only misoprostol had a complete abortion. That's compared with the 96.5 percent of women who were given both drugs.

But misoprostol has the advantage of being widely available even in places where abortion in a medical facility is not.

Still, any abortion is the killing of a child, according to Catholic Bishop Romeo Tovar Estorga, who is from the western Salvadoran city of Santa Ana. "Abortion itself is evil for the mother and the child," he says through an interpreter.

He denounces misoprostol as even worse than surgical abortions, saying that it facilitates the forces of evil.

Yet, globally, misoprostol has been a game changer, says Ann Leonard. She's with the group Ipas, which advocates in favor of abortion access around the world.

"For many years, centuries, women have used sticks and stones and caustic chemicals, all of which caused great damage," she says.

And they've claimed the lives of tens of thousands of women. Ipas estimates that 47,000 women still die each year around the world from complications related to bungled, illicit abortions.

"With the advent of misoprostol women realized they could get the abortion that they felt they needed safely," she says. "They can do it themselves, they can do it in the privacy of their homes, and they didn't have to go to those drastic measures of sticks and bleach."

It's also made the legality of abortion less of an issue. Even in El Salvador, forensic investigators who gather evidence against women in abortion cases say they can't detect whether or not the woman used misoprostol to terminate her pregnancy.

This story is part of a series looking at the health implications of abortions in developing countries. The series will continue for the next two weeks.

Editor's note: An earlier version of this story referred to the use of a "translator" when we should have used the term "interpreter." As reader (and translator) Elizabeth Blount wrote: "In my industry, it is an established fact that a 'translator' works with the written word and an 'interpreter' with the spoken word."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

MELISSA BLOCK, HOST:

Throughout history, even during the time of the ancient Egyptians, women have sought ways to terminate unwanted pregnancies. Often this has led to disastrous results. In the next part of our series on abortion, we're going to hear about a drug that's dramatically changed the way so-called back alley abortions occur. It's been used over the last two decades - an ulcer drug called misoprostol. NPR's Jason Beaubien reports that in San Salvador, where abortion is illegal, doctors credit the drug with saving women's lives.

JASON BEAUBIEN, BYLINE: In the central market in San Salvador you can buy just about anything you want - tomatoes by the wheelbarrow full, fresh goat's milk straight from the goat, underwear, plumbing supplies, fruit, Hollywood's latest blockbusters burned straight onto a DVD. And in the back of the market, in a small stall - lined with jars and dried herbs, roots and mushrooms - you can buy an abortion.

UNIDENTIFIED WOMAN: (Through translator) I have all types of plants to treat all kinds of diseases; for example, problems with your liver, your kidneys, stomach problems, nerves, cancer - for everything.

BEAUBIEN: The woman who runs this shop says she also has a bitter tea that can take care of an unwanted pregnancy. Abortion is completely banned in El Salvador; and punishable with a prison term of anywhere from two to 50 years in prison. So this woman asks that we don't use her name. Her tea only works, she says, in the 1st 6 weeks of pregnancy. If a woman is seeking an abortion later than that, the herbalist arranges to get something far stronger from a local pharmacy - pills used to treat stomach ulcers that are sold generically as misoprostol.

UNIDENTIFIED WOMAN: (Through translator) They come asking for help. Most of them are minors - young girls who say they were raped by their stepfathers, or by people a lot older than them, you know? Sometimes they're being threatened by their stepfathers, that if they tell their moms he's going to kill them or kill the family.

BEAUBIEN: She says when a girl come seeking an abortion it's because her life is in crisis. Often they're crying. They recount tragic tales she says - tales of rape, abuse, betrayal, misguided love. Some of these stories may be embellished but what's clear is that these girls are desperate, and willing to do almost anything to get out of their predicament. The herbalist charges roughly $200 for a course of three pills that would cost less than $5 in a pharmacy in the U.S. Sofia Villalta Delgado, with the Salvadoran Ministry of Health, says this illicit trade in misoprostol has cut the rate of maternal deaths in El Salvador significantly.

SOFIA VILLALTA DELGADO: (Speaking Spanish).

BEAUBIEN: Delgado says before misoprostol women were regularly turning up at hospitals with major complications from botched abortions.

DELGADO: (Through translator) When we were students, when we first started in medicine, women were arriving at the hospital totally septic - with infection in their entire abdomen. You had to take out the whole uterus. This has gone down significantly.

BEAUBIEN: Delgado says the Salvadoran Ministry of Health does not endorse the use of misoprostol for abortion; after all abortion is against the law in El Salvador. But as a public health official, she sees what she says is a public health benefit from the illicit use of this drug. In the year 2000, the food and drug administration approved misoprostol for abortions in the U.S. but only in conjunction with another drug - mifepristone.

The combination of these two drugs has come to be known as the abortion pill. It's also become the most common form of medication abortion in the U.S., Canada, China, India and much of Europe. Misoprostol on its own isn't as effective as the two drug method but it has the advantage of being widely available - even in places where abortion in a medical facility is not. Catholic Bishop Romeo Tovar Estorga, from the Western Salvadoran city of Santa Ana, says any abortion is the killing of a child.

ROMEO TOVAR ESTORGA: (Through translator) Abortion itself is evil; for the mother and the child.

BEAUBIEN: He denounces misoprostol as even worse than surgical abortions.

ESTORGA: (Through translator) And, of course, it is worrisome that it facilitates the forces of evil.

BEAUBIEN: Ann Leonard - with the group Ipas, which advocates in favor of abortion access around the world - says misoprostol has been a game changer globally.

ANN LEONARD: For many, many years, for centuries, women have used sticks and stones and caustic chemicals and all sorts of things - all of which caused great damage.

BEAUBIEN: Ann claimed the lives of tens of thousands of women. Ipas estimates that 47,000 women still die each year around the world from complications related to bungled, illicit abortions.

LEONARD: With the advent of misoprostol, women realized that they could get the abortion that they felt they needed, safely. They could do it themselves - they could do it in the privacy of their homes - and that they didn't have to go to those dangerous and drastic measures of sticks and bleach.

BEAUBIEN: And it's made the legality of abortion even less of an issue. Even in El Salvador, forensic investigators - who gather evidence against women in abortion cases - say they can't detect whether or not a woman used misoprostol to terminate her pregnancy. Jason Beaubien, NPR News. Transcript provided by NPR, Copyright NPR.