Conclusions

The development of abortive methods has enabled women to interrupt their pregnancies in safer conditions with far less suffering than before. Nevertheless, legal restrictions on abortion in most Latin American countries hinder access to the best methods, which is why many women in the region, particularly the poorest ones, continue putting an end to their pregnancies in high-risk conditions.

This situation is compounded by the lack of financial resources prevalent in most Latin American and Caribbean countries, which prevents the widespread adoption of the most effective abortive methods. In countries such as Mexico, for example, many surgical abortions continued to be performed by curettage, instead of manual endouterine aspiration, which, among other advantages, requires shorter hospital stays and permits more rapid recovery.

Despite everything, modern methods, such as medical abortion, are becoming increasingly common, particularly in Guyana and Puerto Rico, as well as Cuba and other Caribbean countries where this practice is permitted and the so-called “abortive pill” RU-486, considered to be extremely effective, is becoming more widely available.

Although at certain stages of gestation or in other cases, surgical methods are recommended, various studies have confirmed that medical abortion has advantages over the latter, including the fact that it can be performed without hospitalization. This method constitutes an important alternative in countries where access to surgical methods is difficult or where abortions are illegal or only available on a restricted basis. Abortion with medicine may even be performed in the woman’s home, which facilitates access and provides a certain degree of anonymity.

According to Berer (2005), methods with medicine have other advantages over surgical abortion. For example, they are easier to obtain, since in certain countries they can be purchased “over the counter” at establishments where drugs are sold, without the need for a medical prescription. They are usually also more affordable, except when there is a parallel market for purchasing them. These methods may prevent a surgical intervention and therefore the use of an anesthetic. This means that many women regard them as more natural and accessible and less traumatic. They also require less intervention by health personnel and less medicalized care, preventing women from being exposed to the criticisms of those that are looking after them. These methods are safer and more effective if they are used in the correct dose and complications are more limited and less serious than with other methods. The possibility of performing these abortions in one’s own home prevents women from being denounced, particularly in countries where access to abortion is limited. Finally, these methods may be practiced at primary health care centers, without a sophisticated medical infrastructure, and not only by doctors but by nurses, midwives and family planning services personnel. Nevertheless, proper training should be guaranteed for all health professionals, to ensure that these products are prescribed in the best possible way.

There is a broad consensus on the acceptability of medical abortion, since properly administered misoprostol may be safe and effective, in addition to contributing to a reduction in maternal mortality. The introduction of the aforementioned methods should be developed to prevent women from resorting to risky methods like those based on plants, the insertion of objects, overdoses of medicine, or the use of chemical or acid products. However, medical or surgical abortion methods also pose challenges for the health system in developing countries, since, as Schiavon (2003) points out, their use requires organizing services for this purpose and training health personnel, in addition to informing the population of the availability and proper administration of existing methods and techniques.

Owing to their positive results, one might assume that in the future, several countries will implement the practice of medical abortion. The World Health Organization has included mifepristone and misoprostol on its list of essential medication. In Guyana, the first of these two products has already been registered as an abortive product (Lafaurie et al, 2005).

The development of better abortive methods is complemented by the use of more effective methods for preventing unwanted pregnancies and therefore abortions, such as emergency contraception. The use of this contraceptive method is extremely effective after unplanned sex, which often happens, or in the event of rape. It is also recommended when couples engage in unprotected sex, when the contraceptive method used (condoms, pills, injections, the rhythm method, abstinence) fails, or in the event of rape, since it is the only method capable of preventing pregnancy in the 72 hours after sexual contact (the so-called morning-after pill can be administered up to 120 days after intercourse, although it is best taken as soon as possible). In Mexico, this method was included in the Official Mexican Family Planning Services Guidelines in January 2004 and is officially offered to rape victims, so that they may choose this alternative if they so desire. It has also been made available to the users of government family planning services, through which it is hoped to prevent unwanted and unplanned pregnancies. According to the Latin American Emergency Contraception Consortium, in addition to Mexico, there are at least 16 other countries in Latin America and the Caribbean where this method has been incorporated into the norms related to family planning (http://www.clae.info/Mecanismos%20de%20Accion/cuadro_resu_nov05.doc).

Greater availability of contraceptives and more effective abortive products in Latin America would undoubtedly benefit the women with the least resources and prevent many of them from continuing to abort or have repeat abortions in conditions that threaten their health and often their lives. It would also enable them to reduce the social inequality and injustice implied by the differing degrees of access to abortion and medical services where its complications are dealt with. These injustices mainly occur in contexts where abortion is illegal and only allowed on certain grounds.

Finally, although several social agents play a role in the dissemination of information and counseling on a wide range of choices of abortive methods, it is the health service providers and non-governmental organizations working in this field that should be regarded as the main protagonists. The expansion of available options to women seeking to terminate an unwanted pregnancy shows the importance of ensuring that they have access to the best, most up-to-date technologies and medical developments and counseling services. In restrictive legal spheres, it is essential that health providers respond by providing the range of services and methods that women need and demand in a manner appropriate to the social and cultural characteristics of the population they treat.

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