MISOPROSTOL AND ILLEGAL ABORTION IN FORTALEZA, BRAZIL

Misoprostol, a prostaglandin E1 analogue indicated for ulcer treatment , has been widely used as an abortifacient by women in Brazil, where a bortion is legal only in cases of rape or incest, or to save the woman 's life. Because misoprostol is an inefficient abortifacient, many wom en who use it have incomplete abortions and need uterine evacuation. W e reviewed the records of women admitted to the main obstetric hospita l of Fortaleza, capital of Ceara state, Brazil, between January, 1990, and July, 1992, for uterine evacuation after induced abortion. The nu mber of incomplete abortions induced by misoprostol increased substant ially during the first half of 1990, and declined thereafter. Of the 5 93 cases in 1991, 75% were related to misoprostol, 10% to the use of o ther specified drugs, and 6% to unspecified drugs. For the remaining 9 % the procedure used was not recorded; these included 3% in whom abort ion had been induced by a clandestine abortionist. The number of uteri ne evacuations per month fell from 89 in August, 1990, to 62 in July, 1991, when sales of misoprostol in Ceara state were suspended. The fal l continued after the sale of misoprostol ceased, to about 20 cases in December, 1991 numbers remained around this level until June, 1992, s ustained by clandestine sales. The lack of access to contraception is the main reason for the large numbers of unplanned pregnancies and is a major public health issue for Brazilian women. The prohibition of ab ortion creates a void in which misuse of medicines is one extra compli cation, mainly because of the poor control of drug marketing.