Amalia Dominguez was 18 and desperate and knew exactly what to
ask for at the small, family-run pharmacy in the heart of Washington
Heights, the thriving Dominican enclave in northern Manhattan. "I
need to bring down my period," she recalled saying in Spanish, using
a euphemism that the pharmacist understood instantly.
It was 12 years ago, but the memory remains vivid: She was handed
a packet of pills. They were small and white, $30 for 12. Dominguez,
two or three months pregnant, went to a friend's apartment and
swallowed the pills one by one, washing them down with malta, a
molasses-like extract sold in nearly every bodega in the
neighborhood.
The cramps began several hours later, doubling Dominguez over,
building and building until, eight and a half hours later, she
locked herself in the bathroom and passed a lifeless fetus, which
she flushed.
The pills were misoprostol, a prescription drug that is approved
by the Food and Drug Administration for reducing gastric ulcers and
that researchers say is commonly, though illegally, used within the
Dominican community to induce abortion. Two new studies by
reproductive-health providers suggest that improper use of such
drugs is one of a myriad of methods, including questionable homemade
potions, frequently employed in attempts to end pregnancies by women
in fervently anti-abortion cultures despite the widespread
availability of safe, legal and inexpensive abortions in clinics and
hospitals.
One study surveyed 1,200 women, mostly Latinas, in New York,
Boston and San Francisco and is expected to be released in the
spring; the other, by Planned Parenthood, involved a series of focus
groups with 32 Dominican women in New York and Santo Domingo.
Together, they found reports of women mixing malted beverages with
aspirin, salt or nutmeg; throwing themselves down stairs or having
people punch them in the stomach; and drinking teas of avocado leaf,
pine wood, oak bark and mamon fruit peel.
Interviews with several community leaders and individual women in
Washington Heights echoed the findings, and revealed even more
unconventional methods like "juice de jeans," a noxious brew made by
boiling denim hems.
"Some women prefer to have a more private experience with their
abortion, which is certainly understandable," said Dr. Daniel
Grossman, an obstetrician with Ibis Reproductive Health in San
Francisco, which joined Gynuity Health Projects in New York in
conducting the larger study. "The things they mention are, 'It is
easier.' It was recommended to them by a friend or a family member."
Dr. Carolyn Westhoff, an obstetrician at NewYork-Presbyterian/
Columbia University Medical Center, said the trend fits into a
larger context of Dominicans seeking home remedies rather than the
care of doctors or hospitals, partly because of a lack of insurance
but mostly because of a lack of trust in the health care system.
"This is not just a culture of self-inducted abortion," she said.
"This is a culture of going to the pharmacy and getting the medicine
you need."
Physicians say that women can obtain the pills either through
pharmacies that are willing to bend the rules and provide the
medicine without a prescription or by having the drugs shipped from
overseas.
It is impossible to know how many women in New York or nationwide
try to end their pregnancies themselves, but in the vibrant,
socially conservative Dominican neighborhoods of Upper Manhattan,
the various methods are passed like ancient cultural secrets. In a
study of 610 women at three New York clinics in largely Dominican
neighborhoods conducted eight years ago, 5 percent said they had
taken misoprostol themselves, and 37 percent said they knew it was
an abortion-inducing drug. Doctors and community leaders say they
have not seen any signs of the phenomenon disappearing, which they
find worrisome because of concerns about effectiveness and potential
side effects.
Sold under the brand name Cytotec, misoprostol is approved to
induce abortion when taken with mifepristone, or RU-486; doctors
also sometimes use it to induce labor, though it is not approved for
that use. A spokesman for Pfizer, which manufacturers Cytotec,
declined to comment beyond saying that the company did not support
the off-label use of its products and noting that the label includes
"FDA's strongest warning against use in women who are pregnant."
That warning, in capital letters, also notes that the drug "can
cause abortion."
But it does not always do so, not least because notions of how
best to use it vary from inserting several pills into the vagina to
letting them dissolve under the tongue. The side effects can be
serious, and include rupture of the uterus, severe bleeding and
shock.
"We do worry because we don't know where women are getting the
instructions from," said Jessica Gonzalez-Rojas of the National
Latina Institute for Reproductive Health, which was a partner on the
Ibis study. "We imagine that there is misinformation on how to take
it, which is why it could be hit or miss."
In 2007 in Massachusetts, an 18-year-old Dominican immigrant
named Amber Abreu took misoprostol in her 25th week of pregnancy and
gave birth to a baby girl who died four days later; a judge
sentenced her in June to probation and ordered her into therapy. In
South Carolina in February, a Mexican migrant farm worker, Gabriela
Flores, pleaded guilty to illegally performing an abortion and was
sentenced to 90 days in jail for taking misoprostol while four
months pregnant in 2004. A Virginia man, Daniel Riase, is serving a
five-year prison sentence after pleading guilty in 2007 to slipping
the pills into his pregnant girlfriend's glass of milk.
Researchers studying the phenomenon cite several factors that
lead Dominican and other immigrant women to experiment with
abortifacients: mistrust of the health care system, fear of surgery,
worry about deportation, concern about clinic protesters, cost and
shame.
Dominguez, for her part, said she had no insurance or money to
pay for an abortion, and could not fathom getting one for fear her
mother would find out. One of her friends had spent $1,200 on an
abortion that left her with a uterine infection, and another friend
endured the procedure without anesthesia, she said. In addition,
Washington Heights is a tight-knit community where abortion - as
well as birth control - is shunned; if Dominguez were spotted
entering a clinic, rumors could fly.
"There are scary moments, and you got to have a friend right next
to you," said Dominguez, now 30 and a mother of four. "It's cheap
but dangerous. Certain people are more delicate than others. But
afterwards, I felt relief."
(C) 2009 International Herald Tribune. via ProQuest Information and Learning Company; All Rights Reserved