The Brazilian experience with Cytotec.

Maternal and Child Health Division, Institute of Health, São Paulo, Brazil.

Cytotec, the commercial name for misoprostol, which is a synthetic analogue of prostaglandin E1, was approved for use in Brazil in 1986 to treat gastric and duodenal ulcers. The drug can and has also been used to induce abortion, which has created controversy in a country in which induced abortion is illegal. A study of the drug was undertaken in 1992 that included analyses of the drug's sales profile, of information published by the media, and of its use from women's and gynecologists' points of view, the latter examined using qualitative methodologies. The analysis of Cytotec's sales volume showed quick growth from its introduction until the first half of 1991, when its use was restricted by the Ministry of Health. For women, Cytotec's main advantages have been that it is relatively inexpensive, convenient to use, and can be used in private. Data obtained from gynecologists show that Cytotec's addition to the obstetric therapeutic arsenal was welcome and also confirmed the drug's influence in reducing the complications of illegal abortions shown in other studies.

PIP: A Brazilian study of 1986-92 sales of the prostaglandin analogue, misoprostol (Cytotec), often used as an abortifacient in Brazil, shows that an increasing trend began in January 1989 and was maintained until July 1991, when the Ministry of Health (MOH) imposed restrictions on Cytotec sales. Cytotec introduced in mid-1986 as a treatment for gastric and duodenal ulcers. Sales reached their lowest levels in 1992 (150,207 vs. 189,199-581,003 annual sales). Other factors contributing to the fall in sales wee reduced production due to an agreement between the manufacturer and MOH, a newspaper campaign by anti-Cytotec groups, and a law for a double-copy prescription. Hospital surveys in the early 1990s indicated that many women used Cytotec to induce an abortion. The media, pharmacies, physicians, women, and the manufacturer spread the news that Cytotec could be used to induce abortion. Women take 4-16 doses of Cytotec to induce abortion, generally during the first trimester. The use Cytotec because it is relatively inexpensive and less traumatic than other abortion methods and can be taken in privacy. Women also consider Cytotec to be safe. Nevertheless, most women complain of the pain they experience and the need to eventually go to a hospital. These negative views are a result of lack of information about the physical process of the drug. Gynecologists of the Sao Paulo public health system confirm the widespread use of Cytotec as an abortifacient. Cytotec allows gynecologists to perform abortions without the police being involved since women induce an abortion with Cytotec, and gynecologists perform a curettage. Hospital staff consider this type of induced abortion more acceptable than other methods. It also allows them to avoid the feelings of inadequacy they experience when women are admitted for an infection caused by a botched abortion or perforated uterus. These findings demonstrate that a favorable atmosphere exists in Brazil to promote the legalization of abortion.

PMID: 8212093 [PubMed - indexed for MEDLINE]