Women’s reliance on the black market for access to medical abortions means that they may not adhere to medical best practices. When C., a 24-year-old teacher in Recife, bought misoprostol from a drug dealer last year, she searched Google for how to use it. “Because it is illegal, there is no information on how to get it or what to get,” she said.
Her search found recommendations for inserting the pill into the vagina, as a doctor would do if she were in the clinic, but warned that traces could be left and sent her away if she was injured in the hospital; Instead, she dissolves them under her tongue, a method that is also effective but less rapid.
C., who requested to be identified only initially for fear of prosecution, bled weeks later and wanted to ask her mother, a gynecologist, for advice. But her mother is an anti-abortion activist. Finally, C. said she thought she was miscarrying, her mother took her to see a colleague to perform dilatation and curettage with anesthetic.
“When I scraped, I had to say to myself over and over again, ‘Don’t say anything, you can’t say anything’ – it was torture,” she said. “Even though I’m absolutely sure I want an abortion, I have no doubt you still feel like you’ve done something wrong because you can’t talk about it.”
The restriction on misoprostol complicates routine obstetric care, which uses the drug to induce labor, Dr. Derraik said. At the Rio public maternity hospital where she works as medical director, a doctor must fill out a third claim for the drug, signed by Dr. Derraik, take it to the pharmacy where the supervisor is must also sign before taking the medication out. locker, and then the doctor has to administer the drug with a witness, to make sure the drug isn’t diverted for black market sale.
“Not all of these steps are formally required,” says Dr. “But hospitals do it because of the intense paranoia surrounding the drug.”
