Resumen : A field study of the availability and use of so-called "high-dose estrogen-progestogen" drugs in Cusco, Peru, was done in 1987 by making an inventory of available drugs, discussing drugs with pharmacists and women, observing 112 consultations with midwives and physicians, interviewing doctors, midwives and nurses, "fake patient" approaches to all 19 pharmacies, and interviewing salesman in pharmacies. 12 such injectable combinations are registered for secondary amenorrhea in Peru, although none are on the 1986 Essential Drug list. Their sales make up 66% of the market for sex steroids (including oral contraceptives), which account for 10% of drug sales in Peru. Women, who are discouraged from using contraception by the Church and by husbands who fear an effect on their virility, demand the drugs for abortifacients, and prefer injections over pills. Injection were done in pharmacies, at health centers, or at home. DOctors also regard them as pregnancy tests, although they have been banned for this use in developed countries. Only 8 of 19 health providers questioned believed the steroids may harm the fetus, and then erroneously only in late pregnancy. 26 incidents of patients being prescribed high dose estrogen-progestins were observed: only 11 patients had pelvic exams. 17 were given for pregnancy termination, 3 with no reason mentioned, and 6 for pregnancy diagnosis or to induce menstruation. Pharmacy sales staff, who stated that they receive information from pharmaceutical representatives, held a wide range of views on indications for these drugs, from the best agent to induce menstruation to the drug to use for an abortifacient. While pregnancy is a contraindication for these medications, they are abused for abortion, indicating a great need for a safe medical abortifacient in Peru.
Web site : http://www.sciencedirect.com/science/journal/02779536