JAMAICAN women have been secretly using a drug intended to treat something completely different, to abort unwanted pregnancies without a doctor’s prescription.

The drug, known as Cytotec — which is the generic name for the medication Misoprostol — was intended to prevent stomach ulcers, but has found widespread use as a means of inducing labour in pregnant women and, in secret, to terminate healthy pregnancies.

The drug, which Sunday Observer sources confirm has become widely available on the local black market, sells for up to $15,000 for a course of treatment, which is about the same it would cost to get a more invasive surgical abortion done by a medical doctor.

One woman in an inner-city community, who spoke on the grounds of anonymity, has been selling the tablets for a number of years. She said demand for the ‘abortion pill’ has grown as more and more persons learn about it.

“Nuff people tek it,” she said. “Both teenagers and big people buy it. It don’t have no specific set a people, and nuff other people want it but don’t know where to get it. Nuff people just start hear bout it, so that’s why you find that more buying it.”

She said the tablets are supplied by another woman who travels overseas and purchases them and smuggles them into the country.

Four to six of the small white pills, she said, are sold on the black market for between $12,000 and $15,000. However, another woman told the Sunday Observer she got four pills for $4,000 at a pharmacy in Portmore.

She also reported that she was able to procure the drug at a downtown Kingston pharmacy, five for $8,000.

The pills are taken both orally and are inserted into the vagina. It is the vendor, without the benefit of medical or pharmaceutical training, who explains to the purchaser how the pills must be used.

The woman the Sunday Observer spoke with explained that all the tablets are taken and inserted at the same time and within an hour, the woman will expel or “bleed out” the foetus. This is usually accompanied by non-stop pain, high fever, diarrhoea, vomiting and the passing of large blood clots.

She noted that she would not recommend that women take the tablets after three months of pregnancy. However, she denied that there were any ill-effects from using them.

“It safe. It not doing you nothing,” she insisted. “A years now it selling and I never hear of anyone getting sick or going to the hospital because of it. It safe man.”

However, while it is an open secret that the drug is available for purchase illegally, some medical doctors are also giving it to their patients, without prescription, for ‘off-label’ use. In most cases, it is given to patients to induce the abortion of a healthy foetus, the Sunday Observer has learned.

Head of the Gynaecological and Obstetrics Department at the University Hospital of the West Indies (UHWI), Professor Horace Fletcher, who reiterated that abortion is against the law in Jamaica, said many doctors and patients nonetheless use Cytotec/Misoprostol to terminate pregnancies, sparking controversy over its use.

However, it has a perfectly legitimate and legal application.

“It is a prescription drug used to prevent stomach ulcers in people who use non-steroidal anti-inflammatory drugs like aspirin or ibuprofen,” Fletcher explained. “It has, however, been found to be very useful in women.”

He explained that Misoprostol has been used to induce abortion or terminate abnormal and normal pregnancies for social and medical reasons, but also to induce labour by softening and opening the cervix; to stop bleeding after delivery (post-partum haemorrhage); and to soften the cervix prior to surgical procedures like dilatation and curettage (D and C), or ‘scraping’ the womb.

Fletcher said it has its advantages and it is widely used in underdeveloped countries on mothers after they have given birth, especially because it does not need to be refrigerated like other drugs.

“It stops women from bleeding to death after having a baby,” he said.

He added that Cytotec has been in use legally in Jamaica for over 10 years. The tablets, he explained, are the most common method of inducing labour in Jamaica.

“We (the local medical fraternity) were one of the first to publish its usefulness in inducing labour,” he said. “And now it has widespread use world wide. It has resulted in a decrease in deaths from high blood pressure and bleeding after pregnancy.”

“In viable pregnancies (when there are no signs of miscarriage or impending pregnancy loss and the pregnancy can be expected to result in the birth of a live infant) near to, or at term, it is used to induce labour for certain conditions, decreasing the need for Caesarean section,” he explained

Nonetheless, he warned against unprescribed Cytotec being used by pregnant women, and offered the reminder that abortions are illegal in Jamaica.

Fletcher noted that the drug can be used legally to terminate abnormal pregnancies, but confirmed that despite this, some doctors are, in fact, giving it to patients who simply want to abort normal, healthy foetuses.

Twenty-three-year-old Alicia (last name withheld) said last year she found out she was pregnant at a time when she simply could not afford to have a child. It was her first pregnancy and she said she just was not ready. Neither was her 38-year-old partner, who already had three children he was struggling to look after.

Four and a half months into her pregnancy, despite feeling the baby’s movements inside of her, she visited a doctor who inserted one of the tablets inside her vagina and gave her two more tablets, instructing her to take them orally within seven hours after the insertion.

Alicia recalled experiencing horrific abdominal pain which felt as if she were giving birth. This was accompanied by very heavy bleeding. All this began within an hour of taking the pills.

“A day and half later, everything pass out,” Alicia recalled. “Ten days later I went back to the doctor to make sure that everything was out.” She was then given a prescription that would prevent any infection from developing as a result of the chemically induced termination.

Alicia said she has not experienced any problems since. However, she says her stomach remains enlarged and her breasts have sagged.

That abortion cost her $10,000.

While he does not know of anyone dying from the unprescribed use of the drug in Jamaica, Fletcher said he is aware of persons in other countries dying from complications associated with the drug.

“It has been a cause of maternal deaths in some other countries as it can cause rupture of the uterus,” he explained. “It can also cause death of the baby from excess uterine contractions.”

He added that the drug can force the fluid around the baby (amniotic fluid) into the mother’s lungs, which could result in death.

But, one reputable gynaecologist who did not wish to be named, said while he is not promoting the use of Cytotec for abortions, the drug is one of the most efficient methods of terminating a pregnancy and safer than abortions performed by many ‘back-door’ doctors using surgical instruments.

“It is much safer than other forms of termination,” he said. “A lot of the complications once associated with abortions have been reduced,” he added.

“We no longer see young girls coming in with their insides rotting out, or developing infections, or persons with their insides dig-up and ruptured from the use of unsterilised instruments.”

“Cytotec is very efficient and it does not leave anything inside of you. Nowadays you hardly see those complications. It’s just that termination is illegal in Jamaica, so it just can’t be used like that. There are specifications to termination of pregnancies, but a lot of complications have been reduced since the ‘abuse’ of Cytotec,” he said.

Studies have demonstrated that Cytotec can be used to terminate pregnancies at any stage of gestation, hence unconfirmed reports reaching the Sunday Observer of unborn babies as old as five and six months being aborted through use of the powerful drug.

Director of Standards and Regulations in the Ministry of Health, Princess Thomas-Osbourne said the ministry is aware of the misuse of the drug and steps are being taken to curb the practice.

“The Ministry has had several reports regarding the illicit use in this way, and harm caused to patients to whom it has been given,” Osbourne said. “A policy has been developed and is to be implemented.”

This policy, she explained, would remove the use of Cytotec from the private sector and allow its access only to gynaecologists and obstetricians who are consultants in hospitals. The medication could then only be used under the direct supervision of these consultants.

“Any use by anyone to procure an abortion is illegal, whether on a prescription by a doctor or dispensed by a pharmacist,” she warned.

Using the pills for abortion is considered to be ‘off-label’. This means that the drug has not been FDA approved for use as an abortion pill, for cervical ripening or to start labour.

Not having FDA approval for this also means there are no standardised dosages or guidelines in prescribing Cytotec for these purposes.

One manufacturer of Misoprostol, Searle, warned consumers in 2000 about the possible risks of the drug if used during late pregnancy.