By Colin Vaida
A Quiet Inquisition
Last month, New York City’s IFC Center invited locals to view Human Rights Watch’s annual film festival. The festival covered a number of topics, including one film that discovered A Quiet Inquisition in the heart of Central America. The film follows the courageous story of Dr. Carla Cerrato OBGYN and sets out to explore Nicaragua’s recently passed anti-abortion law. The law prohibits abortions in any case, as long as the fetus is still alive. Despite the law, Cerrato decides to perform abortions in order to save pregnant women’s lives. This procedure of inducing pregnancy in order to protect the pregnant woman’s health is medically known as a therapeutic abortion. Though the law has instilled fear in patients and doctors it has not been used in any convictions. Without any convictions since the law was enacted, consequences of breaching the law remain uncertain and ambiguous. Cerrato, despite uncertainty and palpable fear, decidedly acts in favor of both national and international medical standards to protect the life of the pregnant mother.
Reproductive rights are severely limited in Central and South America, especially compared to northern neighbors. The denial of basic reproductive rights in Nicaragua has left many like Dr. Cerrato worried. She fears Nicaragua will fail to meet one of its Millennium Development Goals (MDGs) to significantly decrease the maternal mortality rate (MMR). Though Nicaragua’s MMR has decreased steadily since 1990, the rate still stands at 100 maternal deaths per 100,000 live births, compared to 170 in 1990. Nicaragua’s MDG is to decrease the maternal mortality rate to 48 deaths per 100,000 live births by 2015. Given current standing this goal seems out of reach. Cerrato is worried maternal health will continue to plague Nicaragua if doctors like herself are unable to provide appropriate medical treatment and preventative care. The law’s presence has left women afraid to seek medical consultation, leading many to choose dangerous DIY abortions. Central and South American women, always in fear of being reported by doctors, have minimal options and often turn to a black-market alternative: Misoprostol.
Dual Purpose Drug
Misoprostol, according to the US National Institute of Health (NIH), is a drug taken to prevent stomach ulcers caused by pain medications. The drug also induces labor, and in the case for many women in Latin America, has been used to terminate pregnancy. Misoprostol for the termination of unsafe and unwanted pregnancy is not an uncommon practice since South and Central American women discovered its dual use in the late 1980s. The drug, when used properly, is safe and effective, but Cytotec (misoprostol’s brand name) does have dangerous side effects if used incorrectly. In the film, Cerrato uses the drug to save women from life-endangering pregnancy; in fact, misoprostol is recommended and used commonly in the medical sphere for abortions. However, Cerrato claims the drug is increasingly rare in Nicaragua and regulations around Central and South America have created a black market for the drug.
Misoprostol, as stated before can be an incredibly safe alternative if taken correctly. The World Health Organization recognizes its effectiveness as an abortion drug. The creation of a black-market system, however, can lead to serious misuse of the drug. Without medical guidance, health concerns related to internal bleeding often emerge. Taking the drug out of the hands of doctors and into an exploitative black market puts women at risk. Without appropriate reproductive rights legislation that abides by medical standards rather than moral imperatives, abortions will rise and the region will continue to suffer from poor maternal health.
Misoprostol Crosses the Border
Despite worrying trends and use in Central and South America, misoprostol is becoming increasingly popular in Texas flea markets. According to an article in the Atlantic, decreased reproductive rights are translating to a black-market demand for a drug that may show a worrying trend. Despite its ability to be safe, the use of this drug represents desperation. The end result could be US reproductive health akin to the major restrictions in South and Central America. Last year Texas passed a law that significantly affected clinics that provide abortions, severely limiting access to these services. Texas required clinic doctors to obtain admitting privileges to nearby hospitals they could not comply with. As a result, 21 of the state’s 41 clinics are now closed. More regulations will take effect in September, requiring clinics to upgrade to surgical facilities. Pro-choice activists are claiming even more clinics are set to close as a result. These new surgical center regulations would add seemingly unnecessary add-ons to one of the safest procedures in America.
Of all medical abortions, only .05 percent end in complications.
Though the US may seem a long way off from the perils of other countries in the western hemisphere, the consequences of limiting reproductive rights are very clear. Restricting access to contraception, emergency contraception and abortion only leads to increasingly more severe responses from women. These responses include the creation of a black-market for a drug that should only be taken with a doctor’s guidance. Legislation and policy make the transnational sale and use of this drug problematic, not the drug itself. A war on drugs is being blamed for a number of worrying political developments in the Americas region, let’s not add reproductive rights and misoprostol to the list. Appropriate legislation and an assertion from the medical community could save the region money and lives.
Image source: Human Rights Watch/”A Quiet Inquisition”