Side Effects: Complications at The New York Times from DIY Abortions


Several
prominent women’s health advocates are dismayed by a recent New York Times article about
do-it-yourself abortions using the drug misoprostol. The Times piece,
published January 4, mischaracterized a study about the drug, and researchers say the piece is
sensationalist, implying that lots of New York City Latinas are seriously
endangering their health and breaking the law. Some activists now worry that
the Times article could muffle a more nuanced discussion about access to reproductive health care for immigrant women that transcends
the phenomenon of DIY misprostol abortions. 

In the US, misoprostol
— also known by its brand name Cytotec — is
a prescription drug approved by the FDA as one of two medications employed in
tandem to induce non-surgical, "RU-486"-style abortions. The FDA has never approved
misoprostol for solo use for abortions. But in many countries where abortion is
banned, the drug is sold without prescription, and millions of women have taken
it to end their pregnancies. Simultaneously, many women from these countries
have immigrated to the US.
During the past decade, speculation has spread about whether they are commonly
using misoprostol here to self-induce abortions. Anecdotes abound, including many in New York City, but public
health data has been non-existent.

Two
reproductive health advocacy groups, Cambridge, Mass.-based Ibis Reproductive Health and
New York City-based Gynuity Health
Projects
decided recently to do some research. These groups and others
for years have been teaching how to improve the use of misoprostol in areas
where safe, effective abortion is inaccessible. None of the organizations
recommend misoprostol abortions when better ones are available. But where they
aren’t, said Gynuity’s president, Dr. Beverly Winikoff, misoprostol is an
excellent alternative. Several
medical studies
show that when taken during the first two months of
pregnancy, the drug is safe and effective in 85 to 90 percent of cases. Dr.
Daniel Grossman, an OBGYN and senior associate at Ibis, noted that in Brazil
and some other Latin American countries, underground misoprostol use is
credited with helping to dramatically decrease the abortion injury and death
rate among women. In the 10 to 15 percent of cases when misoprostol is taken according
to protocol and provokes a miscarriage but doesn’t finish it, the woman must immediately
seek medical help to complete it. Most problems arise when women take the drug
much later in pregnancy, in inappropriate doses, or without quickly seeking
medical follow-up for complications.   

But many
such problems could be prevented by doing "harm reduction" education about
misoprostol in communities who are already using it, Grossman and Winikoff
argue. Such efforts often go on under the public radar, because of fears about anti-abortion
political backlash. To explore whether education programs could be appropriate
in the US, Gynuity and Ibis in 2007
quietly started surveying hundreds of low-income Latinas visiting reproductive
health clinics in New York, Boston, and San Francisco. The women were asked if
they had ever tried to abort themselves in this country. 

So what did
the study find? Far less misoprostol use than expected, it turns out. Data
analysis isn’t finished yet and the study won’t be published until March. But
Grossman said that 1,200 women were surveyed, and at most, only 17 reported
using misoprostol at all, let alone in the US. "You absolutely cannot use this study to
generalize beyond the groups we studied," he warned. "But the vast majority of
the women we talked to went to medical facilities, like Planned Parenthood, to
get their abortions. Misoprostol use was not common."

But the Times
tells a different story. It says the study finds that in Latina immigrant
enclaves like Upper Manhattan, misoprostol is "frequently employed …despite the
widespread availability of safe, legal and inexpensive abortions in clinics and
hospitals."  

When Times
reporter Jennifer Lee contacted the Ibis and Gynuity researchers in
December, they could not understand why the Times was doing a news
story. We said, ‘There’s no news now about misoprostol,’" said Winikoff. "We
told her, ‘Maybe there will be if you wait for the study.’" Their fears about premature use of their research were well
founded. Lee’s editor at the Times, Jodi Rudoren, told RH Reality Check
that when Lee talked to her about the study to make a case for an article, she
gave an estimated figure for women reporting misoprostol use that far surpassed
what the researchers say is correct. 

And the Times
article hammers misoprostol’s dangers, while completely ignoring all the research
supporting its potential for relatively safe and effective DIY use. "We told
her about that data and our education efforts,"
Grossman said. Both topics have been covered
in other
publications
in recent years.  

The Times
article also states — wrongly — that self-induced abortions in New York are
"illicit," and women do them "illegally." In fact, according to the Guttmacher
Institute, 38
states outlaw self-abortion,
in laws which often track repressive statutes
left over from pre-Roe v. Wade days. But New York isn’t one of them — women
there can legally self abort early pregnancies if they want to.   

Jessica
Gonzalez-Rojas, director of policy and advocacy at New York-based National Latina Institute for
Reproductive Health
, also was interviewed for the Times story,
and she is disturbed by the resulting article. "We dispute the Times’
implication that accessing clinics is very easy," she said. "There’s the idea
among undocumented women that they’ll be deported if they go to a clinic, and
the Times is wrong about the price of an abortion being cheap for many
women."

After the Times
piece came out, the national media followed with articles saying
that misoprostol use among US Latinas is common, increasing, risky and illegal.
As a result, Gonzalez-Rojas said, "there could be legislative action" to
further outlaw or crack down on self-induced abortions, "including to
criminalize women’s use of misoprostol" in the name of protecting them. "We do
have concerns."

Dr. Anne
Davis, an OBGYN and medical director of New York City-based Physicians for Reproductive Health and Choice,
has more fundamental objections. An OBGYN with a practice in Upper Manhattan
that includes many low-income, Latina patients, Davis said she felt the Times
article "was trying to do a bit of an ‘us versus them’ thing," implying that
poor, immigrant women have completely different attitudes than Times
readers do.  "There are plenty of people
in Upper Manhattan who are having abortions by accessing the system; they are
the overwhelming majority of the community," she said. "Misoprostol is a
complex subject. I have seen many women who’ve used it. And I have seen serious
complications. But misoprostol is absolutely appropriate for abortion if
there’s no other option. The problem is, there is a medical discussion and a sociological
discussion about what’s right for women." When either conversation intrudes on the other without careful research, thought, and language, David says, needless controversy results.  The message from any discussion of misoprostol, she says, is that "We need to do better for women and make
sure all of them get good reproductive medical care as soon as they need it.
That’s the most important thing."  

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  • http://abortionabout.com invalid-0

    The Times, and subsequently much of the other mainstream media, was eager to blindly engage the misoprostol abuse issue when they thought a case could easily be made in favor of their cause. Unfortunately, for them, when they finally had their eyes opened, they found themselves standing in the middle of much larger and more complicated issues. Now, most of them are scrambling to get out rather than staying to face these larger oppressors of women.

    Sadly, it is this kind of misbehavior that leaves many important issues unaddressed and unresolved.

    One Dove
    AbortionAbout.com

  • http://susiebright.com invalid-0

    I knew this NYT story was full of it, and I got a bad feeling in my stomach that it was sensationalizing in a way that was going to be to our detriment. Thanks for doing this story, Debbie.

  • kirsten-sherk

    You know, this is a tough story to read (as an advocate) and I suspect to report on too. On the one hand, we do have better-than-anecdotal evidence that women do use misoprostol on their own to end unwanted pregnancies; how do we tell that story in a reasonable detached way that respects women’s experiences and autonomy? On the other hand, for those who don’t live in this movement, taking misoprostol without the prescription is only a few steps from making a tea with Queen Anne’s lace, or douching with lye, so any article addressing this issue must carefully and consciously draw a distinction between miso and rueda.

     

    I think Dr. Davis makes a very good point – miso use is real, but it’s not a simple issue of economics or culture. For another example of an article about misoprostol use in the U.S., Laura Tillman at the Brownsville Herald wrote a story along these lines last year that reflects Dr.Davis’ experience.

     

    So I guess as we worry about the impact of this article, my question is: do women benefit by public discussion of obstacles (and strategies) to clinic-based abortion care? Why or why not?  And if so, what’s the story that we would like to see told?

     

  • debbie-nathan

    Kirsten,

    You probably agree with me that in the long run, women do benefit from all efforts to nuance the language around abortion issues. Over the past 30+ years, abortion rights — and feminism in general — have been under such strong attack that a predictable and understandable defensive response from progressive women’s advocates is to simplify our language and the presentation of very complicated issues, partly because we’re too busy trying to defend things, partly because we hope that sweeping messy issues under the speech rug will keep them from being exploited by people who are not friendly to women’s rights. But in the long run, simplifying and concealing tends to boomerang, and I also think it saps our activism of its energy. If progressive politics is, ultimately, a celebration of humanity and life in all its "life-ity" — and if feminism is even more dramatically more so sometimes, then we need talk, talk and more talk, no matter how woolly or puzzling it might get, to keep that life force at play.

    On the other hand, there are short run questions. Some might feel that in given political circumstances, it’s better to keep facts and nuance on the down low. But it’s too late for that with Cytotec; there’s been too much press on it already. (In fact, the Times piece was apparently inspired by the just-released Planned Parenthood report on Dominican women’s health care needs in New York. But that report had only 12 US women in it, and while some said they’d heard of Cytotec, none were quoted as saying they’d used it in the US).

     

    So since the cat’s out of the bag on this issue, I think it’s really important to intervene when the talk is careless, especially when it comes from such a prominent place as the New York Times. Glad to see you linked to the Brownsville-Herald piece about use of misoprostol on the Texas-Mexico border. I linked to it, too, in my piece for RH Reality Check, because it is a great example of careful journalism. I lived for many years on the U.S.-Mexico border and know that it is a special place because of its political geography: women go over the border to buy every kind of medicine imaginable in Mexico; everything’s OTC, from antibiotics to birth control pills (much cheaper than in the US!) … Meanwhile, women on the Mexico side (where abortion is illegal) who have green cards or commuter passes make up huge percentages of the patients at South and West Texas abortion clinics.

    When I lived in El Paso, the administrator of the biggest clinic in the city told me (for a story I did) that many of their clients came to be treated after putting objects up themselves to abort (rubber bands was an item she mentioned). Then, they got infected and sought treatment at her place. That was in the early 1990s, before Cytotec. I imagine that in South Texas now, where the population is over 90% Latino, women on the Mexican side AND women on the Texas side are going to these clinics for care after suffering misoprostol complications. Because these two communities are so utterly joined at the hip, and because abortion in South Texas is literally so hard to access, that Brownsville-Herald reporter had a relatively easy time conceptualizing and describing, compared to what one has to do with the issue in New York City. Still, it’s typical for the Texas media to sensationalize issues dealing with abortion. Therefore the Brownsville-Herald piece stands out as wonderful reporting. This is a tiny paper in a culturally conservative community, and if the Texas reporter could do such a good job, the New York Times should be able to do the same if not better.

  • http://ytlparasaymamakinesi.com invalid-0

    The presorting and the use of containers allow highly automated processing of the mail, both in bulk and piecewise, in processing facilities called bulk mail centers (BMCs). We include all the tools you need to successfully mange your bulk mail campaign; from importing to printing. They have asked mailing companies to describe how they would handle the distribution and transportation of parcel mail, and to bid on the work, which is currently performed by union members at Bulk Mail Centers.

  • http://mmohut.com invalid-0

    DIY Abortions? Thats absurd. That must be painful and ineffective.