Abstract : In South Africa, where quinine sulfate (300 mg tablets) is widely available over the counter for malaria treatment, this agent is also used as a contraceptive and abortifacient. Unpublished surveys conducted in 1993 and 1995 in KwaZulu-Natal among 61 private pharmacists and 76 quinine-purchasing clients investigated this phenomenon. 50% of pharmacists reported they sold quinine to an average of 2-6 clients per day. Quinine purchasers tended to be Black women 20-29 years of age who claimed they used the tablets for "birth prevention." Most women ingested 1-2 tablets after sexual intercourse--a dosage too low to have abortifacient action. Users reported side effects such as skin rash, tinnitus, blurred vision, nausea, and vomiting. In focus group discussions conducted in Durban, all participants were aware of quinine use for pregnancy prevention and 23% of women had taken it themselves for this purpose. Unexpected was the finding that men often take quinine to "weaken the sperm" and thus prevent conception. Other researchers have found that use of large doses of quinine as an abortifacient result in substantial maternal mortality and congenital abnormalities and few pregnancy terminations. The toxicity and teratogenicity of this agent merit serious attention. It has been speculated that quinine's toxicity is reduced in malaria because of tissue binding in plasmodial infection.
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