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Logo of Phnom Penh Post newspaper Phnom Penh Post - Medical abortion drugs set for Cambodian registration

Medical abortion drugs set for Cambodian registration

Many hope the imminent introduction of medical abortion drugs will save women's lives by providing a safe alternative to black-market abortion pills.

Abortion drug facts
Mifepristone is also known as RU-486 after the French company Roussel Uclaf that first developed it. Misoprostol was first approved to treat gastric ulcers, but in Brazil in the late 1980s, women discovered it could be used to induce an abortion.

FIVE years ago, a young woman found herself needing to terminate an unexpected pregnancy. Shy and fearful of hospitals, she instead turned to an unlicensed pharmacist who prescribed unidentified pills.

"After I took the tablets, a few days later I lost a lot of blood, and I hurt very much in my stomach," Pheap, now 32, told the Post. "I could not do anything because I was very tired and had to sleep all the time."

Concerned for her health, Pheap's landlady took her to an unregistered clinic where she received a surgical abortion. There were no complications, and she made a full recovery, but other women in Cambodia haven't been so lucky.

Although Cambodia legalised abortion in 1997, tens of thousands of women still opt for unsafe surgical procedures at unregulated clinics or black-market pills.

A 2008 study published in the British Journal of Obstetrics and Gynaecology (BJOG) estimated that in 2005 almost 32,000 women in Cambodia were treated at government facilities for abortion-related complications. Forty-two percent of the cases were severe.

In a bid to make safe abortions more accessible, the Department of Drugs and Food is set to register the drugs mifepristone and misoprostol, said John Naponick, who works with the government as director of the Reduction in Maternal Mortality Project.

The move would allow pills that can terminate pregnancy to be legally imported into the country and is being heralded as a step towards improving access to safe abortions.

"Although abortion is legal, that is not the same as accessible," said Tamara Fetters, a senior researcher at the nonprofit women's group Ipas and primary author of the 2008 BJOG study on abortion-related complications. "Many parts of the country still have limited or no access to safe abortion."

I did not have someone to discuss it with ... I was like a crazy person.

The secrecy and shame surrounding the issue, Fetters said, leads many women to seek help outside the formal health sector. "Abortion is a stigmatised service," she said. "Women who seek abortions are often chastised. They may do it without the knowledge or support of their families."
Sovan Rasmey, 33, underwent an unlicensed abortion two years ago, not realising the procedure was legal. She said could not speak to anyone about it without risking the scorn of her community.

"I went to do it by myself, and, until now, I have kept it a secret," she said. "I did not have someone to discuss it with because I did not want anyone to know. I was like a crazy person."

Women forced to resort to illegal procedures may be risking their lives, Fetters warned. "Drugs are purchased from pharmacists and from drug sellers in markets, so women are largely at the mercy of these vendors and their local knowledge," she said. Though some of the drugs may be effective, other substances "could cause toxicity or haemorrhage that can be life-threatening".

Naponick at Maternal Mortality Project said many Chinese-made abortion medications are dangerous for the simple reason that few people in Cambodia can read the instructions.

"All over Cambodia, there are all kinds of products up for sale," he said. "If the whole package is in Chinese, I don't think anyone will be able to read the expiration date."

Naponick said the societal benefits from the introduction of legal abortion drugs will spread into the informal sector. "If we have a product on the market which is legitimate with instructions that people can read, I would think the situation would be a lot better.... Having a safe, reliable, genuine product in the country is something that we've wanted to have for a long time."

Cambodia has among the highest rates of maternal mortality in the region, according to the 2005 Cambodia Demographic and Health Survey - the most recent data on maternal health. At 472 deaths for every 100,000 live births, it is 10 times higher than Thailand's.

The exact number of deaths caused by unsafe abortions is unknown, said Joan Venghaus, a technical adviser to Marie Stopes International. "A lot of what we are hearing about backstreet abortions is anecdotal.... We don't even know how many people are accessing them," she said.

The World Health Organisation estimates that about 13 percent of global pregnancy deaths are caused by unsafe abortions.

Additional reporting by Eleanor Ainge Roy

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