How many women induce their own abortions?

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While recent media reports have raised concerns over women inducing their own abortions, particularly with a cheap ulcer drug called misoprostol, a new study suggests that the practice may actually be relatively rare.

However, the reported one or two out of every 100 women having self-induced an abortion only reflects those subsequently seeing a doctor about it and, therefore, may underestimate the true rate of the risky abortion.

“A majority of women having abortions are poor or low income, and many lack health insurance,” researcher Rachel K. Jones of the New York City-based Guttmacher Institute, a nonprofit organization focused on sexual and reproductive health, told Reuters Health. “So coming up with the money to pay for abortion services can be difficult if not impossible for many of them.”

In 2005, 1.2 million abortions were performed in the U.S. The price tag in 2006 for a first trimester procedure was around $430; the average charge in the second trimester: $1,260.

Meanwhile, studies have shown that misoprostol (also known as Cytotec), at about $2 a dose and usually obtained on the black market, can achieve complete abortion between 70 and 94 percent of the time.

The relative ease, effectiveness and low cost of the drug can be very appealing to a woman seeking to end her pregnancy, Jones added. But many of these women may be unaware of the proper dosage or administration of the drug that is only FDA-approved for the treatment of ulcers. Its use can result in an increased risk of complications, including severe bleeding and incomplete abortion. If the pregnancy persists, birth defects are possible.

Then there are the potential legal ramifications: Abortion without medical supervision is illegal in many states.

But just how widespread of an issue are self-induced abortions? To determine if there is real reason to worry, Jones looked to data from about 10,000 patients visiting nearly 100 abortion facilities across the country.

She found that only 1.2 percent of women obtaining abortions reported ever having used misoprostol to self-induce an abortion. Another 1.4 percent admitted to trying other substances such as vitamin C or herbs to end a pregnancy, she reports in the American Journal of Obstetrics and Gynecology.

Further, foreign-born women were twice as likely as those born in the U.S. to report ingesting misoprostol or another substance to terminate a pregnancy.

“Only a very small proportion of abortion patients reported having ever used misoprostol to self-induce abortion, whereas some abortion providers believe that a substantial minority of their patients have used this drug in the past,” said Jones. She pointed to one newspaper article that noted that some providers believe up to 40 percent of women coming into their facility have taken misoprostol to end the current pregnancy.

Jones noted that the rates she found are likely underestimates. Many women may be reluctant to report self-inducing for legal reasons. For example, around 5 percent of patients filling out the questionnaire skipped the questions on recent and ever use of misoprostol or other substances.

And others who use misoprostol may never actually visit an abortion clinic.

“In order to understand the full scope of the issue, we need research on women’s experiences with self-induced abortion outside of abortion clinics before we can determine whether enough women successfully self-induce to impact official abortion rates,” noted Jones.

“Women who feel they cannot carry an unwanted pregnancy to term,” she added, “need the information and resources that will allow them to seek help from trained professionals to ensure a safe procedure.”

SOURCE:  American Journal of Obstetrics and Gynecology, online September 23, 2010.

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