A Pill in the Lifeworld of Women in Burkina Faso: Can Misoprostol Reframe the Meaning of Abortion

Abstract

In Burkina Faso, induced abortion is socially stigmatized, condemned, disapproved and legally restricted to cases of rape, incest, fetal malformation or endangerment to the life of the mother. Many women often resort to unsafe procedures to induce abortion, which puts their health at great risk. Misoprostol, which is officially restricted to the treatment of postpartum hemorrhage or post-abortion care, is also used illegally by women to terminate their pregnancies. Misoprostol represents an addition to the existing abortion methods, such as vacuum aspiration, which health workers have often used to induce abortion clandestinely. Many women also use misoprostol to self-induce abortions, replacing abortifacients such as herbal teas, potions, high doses of antimalarial drugs, or bleach. Despite the changes that occur in abortion access due to the use of misoprostol, little is known about what the drug means to its users and how this meaning can in turn influence the meaning of abortion. The aim of this paper is to describe how the use of misoprostol to terminate pregnancy contributes to changing women’s perception of the meaning of abortion. This paper is based on ethnographic fieldwork conducted between March 2016 and February 2017 in the city of Ouagadougou, Burkina Faso. By examining the relation between the use of misoprostol and the meaning that women give to abortion, this study found that women experience abortion either spontaneously or using emergency contraception with misoprostol. Through the experience of women, this paper claims that the meaning of abortion should be seen as a social construct and fundamentally rooted in individual practices and experiences rather than being subject to dichotomist global discourse.

Misoprostol: The Social Life of a Life-saving Drug in Global Maternal Health

“…For example, as a new generation of activists emerges whose mission is to make evidence-based information on misoprostol for self-induced abortion widely accessible, it will be important to track how they are faring and what are the social and political reverberations of their work in specific locales. For another example, drug traffickers, black market sellers, physicians, pharmacists, generic producers, and Internet pharmacies will continue to play significant roles in the circulation of misoprostol in many jurisdictions; such networks of distribution and profit making have only begun to be mapped and described (Drabo 2019; de Zordo 2016, 30). Finally, the impact of these many lives of misoprostol must continue to be followed into the hands and bodies of women themselves with attention to the varied and particular ways they are used and made meaningful.…”

“…In many jurisdictions where safe and/or legal abortion is unavailable or inaccessible, misoprostol now exists in a sort of gray market where the drug is legal and available for its original indication and may be used off-label in hospital by obstetricians (though not for medical abortion). Where the sale of misoprostol has been severely restricted or suspended by health authorities over concerns about “misuse”—in Brazil, Chile, and Mexico, for example—it can be acquired on the black market for highly inflated prices (de Zordo 2016; Drabo 2019). 4 Even in jurisdictions where abortion is legal and relatively accessible, the drug is still dogged by controversy.…”

A New Approach in the Induction of Labor with Misoprostol Vaginal Insert in High-Risk Pregnancy Obese Women

“…The studies on uterine contractility have shown that a sustained level, rather than a high serum level, is required to develop regular uterine contractions [11]. Its uterotonic and cervical-ripening actions are widely used in obstetrics and gynecology; more than 30 dosage regimens are described regarding this matter [21,26] with side effects dose-related, usually transitory, and well-tolerated [27]. Manifestations of toxicity include hypertonic uterine contractions, fetal distress and death, hyperthermia, rhabdomyolysis, hypoxemia, respiratory alkalosis, and metabolic acidosis.…”

“…The plasma levels of misoprostol were sustained for a long time after vaginal administration (six hours vaginal route vs. four hours via sublingual route) [11,[18][19][20]. Adequate plasma levels enable vaginal misoprostol in specific applications such as second-trimester medical abortion [18,21].…”

Is Misoprostol Vaginal Insert Safe for the Induction of Labor in High-Risk Pregnancy Obese Women?

“…Misoprostol’s uterotonic and cervical-ripening actions are generally used in obstetrics and gynecology. More than 30 dosage regimens are described regarding this matter [ 18 , 19 ], with side effects being dose-related, usually transitory, and well-tolerated [ 20 ]. Clinical manifestations of toxicity include hypertonic uterine contractions, fetal distress and death, hyperthermia, rhabdomyolysis, hypoxemia, respiratory alkalosis, and metabolic acidosis.…”