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

Researchers say a recent New York Times piece on off-label misoprostol use misses the point, implying that New York City Latinas are seriously endangering their health while ignoring safe use in countries where abortion is illegal.

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.

reproductive health advocacy groups, Cambridge, Mass.-based Ibis Reproductive Health and
New York City-based Gynuity Health
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

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 Rewire
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
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.   

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

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."