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ARGENTINA: Safe Shortcut to Sidestep Illegal Abortion

Marcela Valente

BUENOS AIRES, Aug 14 2009 (IPS) - Tired of calling for the decriminalisation of abortion – the leading cause of maternal death in Argentina – a network of women's rights activists launched a telephone hotline to inform women on a safe abortion method that requires no medical intervention: the use of a pill to terminate pregnancy.

"We make information approved by the World Health Organisation (WHO) and the Latin American Federation of Gynaecology and Obstetrics Societies available to women," Verónica Marsano, a member of Lesbians and Feminists for the Decriminalisation of Abortion, the organisation spearheading the initiative, explained to IPS.

According to this information, a drug called misoprostol – also known as RU486 or medication abortion – can be used by women to safely interrupt an unwanted pregnancy up to the ninth week of gestation. The medicine, which works by causing contractions of the womb that result in the body expelling the pregnancy, has an effectiveness rate of more than 80 percent. "The associated risk is one percent and is never mortal," said Marsano, who received special training for the initiative.

Since it was launched in late July, the phone line, which operates seven days a week, has received an average of 15 calls a day from women around the country.

The experience, backed by the Dutch-based international organisation Women on Waves, was first introduced in Ecuador in June 2008, where a hotline is run by the Youth Organisation for Gender Equity. Despite the fact that abortion is illegal in Ecuador, an estimated 95,000 abortions are performed every year in that country.

In view of the good results obtained through the dissemination of information on misotropol in Ecuador, the Women’s Health Network of Chile decided to implement a similar initiative in May 2009. Chile is one of the few nations in the world where abortion is illegal under all circumstances, but estimates place the number of interrupted pregnancies in that country at 120,000 to 160,000 a year.

In Uruguay, guidance in the use of misoprostol is in place since 2001 in the pre and post abortion counselling clinic in Montevideo’s Pereira Rossell Hospital, the state maternity health facility. In Argentina, medical counselling on this medicine-based option is also available, in this case through the adolescents clinic at the state Argerich Hospital, in Buenos Aires.

But the idea of the network of women's activists for starting a telephone assistance service was aimed at making information available to women around the country, enabling them to make an informed decision without having to go to a hospital. "We don’t give advice, we provide information," Marsano explained.

Nevertheless, they work with a protocol designed by specialists and are advised by a committee of doctors.

In an interview with IPS, Dr. Mabel Bianco, president of the Women’s Studies and Research Foundation, said that "medication abortion is a significant advance. It’s a less bloody and invasive method, which requires no surgical intervention or anaesthesia."

According to Bianco, "it has proved very useful in countries around the world in reducing the risk of death and complications for women." She also underlined that it has the advantage of giving women the possibility of using it "privately and without having to ask for professional assistance."

The network’s activists were trained by doctors with Women on Waves, whose members travel around the world performing abortions in international waters, near countries that ban the practice.

The women trained to answer the phone service tell callers how to obtain the drug – which was originally developed to treat gastric ulcers – without a medical prescription, the dose that must be administered to obtain the desired result, the effects of misoprostol on their bodies, and possible complications.

The risks and experience are similar to those of a miscarriage, they say: cramps, bleeding and possible nausea, vomiting and diarrhoea. The network advises women to have a sonogram before they take the drug, to determine how far into the pregnancy they are and to rule out an extra-uterine (or ectopic) pregnancy.

"Our ultimate goal is to influence the debate on the need to decriminalise abortion, but meanwhile we offer information on this widespread method, because part of the goal of reducing maternal mortality is to give women access to information," Marsano explained.

In Argentina, abortion is a crime punishable by imprisonment, except in cases where the pregnancy is the result of rape, when the mother’s life is in danger or when she is mentally ill or disabled.

But every year some 460,000 to 600,000 women resort to abortion, according to the report "Estimate of the Extent of the Practice of Induced Abortion in Argentina," prepared by experts from the University of Buenos Aires and the Centre for Population Studies.

In the book "Abortion under Debate," Mariana Carbajal, a journalist who specialises in women’s issues, writes that every hour seven women are discharged from a public hospital in Argentina after being treated for abortion-related complications.

But that’s only the tip of the iceberg, Carbajal says.

Complications resulting from abortions have been the leading cause of maternal death in this country for the past 25 years. According to the latest Ministry of Health figure, from 2007, the maternal mortality rate stands at 44 deaths for every 100,000 live births.

This falls far short of meeting the target set in the Millennium Development Goals (MDGs), agreed by 189 heads of state at the United Nations’ Development Summit in 2000 to address major development issues.

Under Goal 5 – the MDG that relates specifically to maternal health – signatory nations undertook to reduce the maternal mortality rate by three quarters, between 1990 and 2015.

"The State has to meet this target because deaths from abortion are avoidable. We are merely fulfilling the role that the State should be playing if it really intends to fulfill the target," Marsano said.

According to the 2009 Millennium Development Goals Report, issued on Jul 6. by the United Nations as part of its assessment of the progress made, obstetric complications and complications from unsafe abortion account for the majority of maternal deaths.

But in spite of the lack of public policies, doctors note that the number of hospitalisations for abortion-related complications has gone down in recent years due to the use of misoprostol, which women learn about by word-of-mouth from other women, Dr. Estela Acosta of the Ana Goitía de Avellaneda Maternity Clinic, on the south side of Buenos Aires, told Carbajal.

"For us, it’s truly a relief. They used to come in with infections, facing the risk of death or loss of their uterus or ovaries. Access to these drugs that interrupt pregnancies has pushed hospitalisations and risks down," said Acosta.

A similar assessment was made by Dr. Ricardo Cuevas, of the Gynaecology Service of Soria Hospital, in the north-west province of Jujuy. The number of hospitalisations as a result of abortions dropped 50 percent since 2002 due to misoprostol and also to the dissemination of and better access to birth control, Cuevas is quoted as saying in the book.

Still this is only a shortcut for achieving safe abortion. Both Bianco and Marsano said that the women’s movement needs to continue fighting for the decriminalisation of abortion.

Or at the very least, women must organise to demand real access to abortion in hospitals in those circumstances under which it is deemed legal, because in practice rape victims and others have had to bring legal action to exercise their right to terminate a pregnancy.

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