Ever since the abortion pill RU-486 began to hit the market in the 1980s, questions have lingered about its safety, especially for women who take it in countries where terminating an unwanted pregnancy is restricted and they cannot openly seek help from a medical professional if something goes wrong.
As reports of deaths and injuries grew in the early 2000s and the pill became a big political issue, studies were launched to try to get more data on the safety question. The results are starting to come out.
Last May, the British journal the BMJ reported on the use of the pill in Ireland and Northern Ireland — which have some of the most restrictive laws on surgical abortions — and found that medication abortions done at home with drugs sent via the mail were about as safe as those administered in a clinic. Of 1,000 women who were tracked, using data from a nonprofit that helps women seeking abortions in 140 countries, 95 percent reported that they had successfully ended their pregnancies. Though seven women had serious complications requiring blood transfusions, less than 10 percent had symptoms such as heavy bleeding, fever or pain — similar to the percentage reported at clinics where the pill can legally be given.
The latest research, published this week in PLOS One, focuses on the experience of 220 women the Peruvian cities of Lima and Chimbote. They had been evaluated by nurses, given information about how to use the drug misoprostol and encouraged to return to a clinic for follow-up. The rates of success and adverse events were similar to those in the previous study, with 89 percent of women having a complete abortion. Only two had a major complication, which in both cases was an infection.
“Our findings corroborate those from a growing number of studies indicating that women can safely and effectively use medication abortion on their own with minimal clinical supervision,” Daniel Grossman, a professor of obstetrics and gynecology at the University of California at San Francisco, said in announcing the results.
Grossman and his colleagues described the clinic counseling as a type of “harm reduction model” that may lower the risks associated with improperly conducted surgical abortions and self-induced alternatives.
In the United States and many European countries, RU-486, or mifepristone, is typically used with misoprostol to terminate pregnancies. But the pill is not readily available in some parts of the world, and in those situations, as in the Peru research, doctors recommend using misoprostol alone.
“Worldwide, unsafe abortion is estimated to account for 8-18% of maternal deaths as well as a large number of medical complications,” the authors of the latest study write. Liberalization of restrictive abortion laws appears to result in improved health outcomes, but in the interim or absence of such changes, giving women information about misoprostol may save lives, they conclude.