MOSCOW, November 2, Tatyana Pichugina. In Russia, the number of abortions decreases every year. At the same time, the proportion of medical abortions, which are considered less traumatic, is growing. However, data on the long-term consequences of this type of intervention are very scarce, and doctors are increasingly talking about significant health risks. And recently, the Ministry of Health tightened control over such drugs.
History of birth control pills
In the 1970s, effective hormonal contraception was invented, giving society a powerful tool to control childbirth. However, the problem of unwanted pregnancies remained, and scientists dreamed of creating a magic pill that would eliminate conception in the earliest stages, “as soon as the sperm and egg merge.” It would be enough to take it once a month.
By that time, the role of receptors for the hormone progesterone, which is activated in the first phase of the cycle, preparing the female body for pregnancy, became clear. There are especially many of them in the endometrium of the uterus. The idea was to block the receptors and prevent conception.
Research progressed slowly, writes one of the pioneers of hormonal contraception, biochemist Etienne-Emile Beaulieu, who recently celebrated his 96th birthday, in his monograph. Even the pharmaceutical company Roussel Uclaf, which he advised, did not believe in the success of steroids. “In addition, many colleagues objected to them because of religious and social beliefs,” the scientist notes.
Beaulieu and his colleagues methodically sorted through candidates for hormone therapy, hoping that sooner or later something would be found. In the 1980s, they finally came across a compound (designated RU 486, later mifepristone) that bound to progesterone receptors in the same way as the hormone itself.
After testing on animals, clinical studies began. However, the effectiveness was low: pregnancy was terminated in 65 percent of cases. If combined with prostaglandins (these lipid compounds are active in almost all human tissues), the indicator increased to 95. Misoprostol, used to treat stomach ulcers, was especially suitable for this.
In 1986, RU 486 was approved in China. Two years later, having overcome serious opposition from opponents of abortion, in France. The Vatican immediately declared this a new serious threat to human life. US President Ronald Reagan banned the import of the drug. It was only allowed there in 2000. In the same year, mifepristone entered the market in Russia and a number of other countries.
What the statistics say
The WHO believes that “medical abortion has revolutionized access to quality abortion services in the world.” Surgical abortions are being performed less and less. If in 1990 there were more than four million in the RSFSR, then in 2022, according to Rosstat, there will be half a million. Although this is a lot.
As experts from the Rostov State Medical University note, artificial termination of pregnancy leads to complications in 33 percent of cases, and death in 18 percent. Abortion causes psychological trauma and increases the risk of health problems in future offspring.
Medical abortions are highly effective, tolerable, do not require hospitalization, anesthesia, and fewer complications.
«Two drugs are taken: mifepristone and misoprostol. The first exfoliates the contents of the uterine cavity, namely the fertilized egg. The second contracts the uterus and expands the cervical canal of its cervix. Complications — incomplete abortion (when part of the fertilized egg is preserved), bleeding, severe pain, infections. These are “, of course, this happens rarely, but performing a medical abortion on your own is strictly prohibited,” explains obstetrician-gynecologist Emma Shustikova.
In addition, there are strict restrictions. Firstly, it is necessary to exclude ectopic pregnancy, and secondly, to establish the timing of pregnancy (no more than 63 days of missed menstruation). And it is impossible to determine the dosage and timing of taking the drugs on your own.
Deceptive security
These drugs are not commercially available. Nevertheless, they can be found on the Internet, including often counterfeit ones, which leads to tragedies. State Duma deputy Elena Mizulina drew attention to this several years ago.
“I can’t imagine how you can do such a procedure yourself. This is very dangerous, since the patient does not know about the state of her health, does not take into account risk factors and complications, and is not able to monitor herself and control the process. Only a doctor can calculate the exact duration of pregnancy. Consequences — from infertility to death,” says Ekaterina Varlamova, obstetrician-gynecologist at Meditsina JSC (academician Roitberg’s clinic).
June 20, 2022, 08:00
“Any termination of pregnancy is harmful to health. The drug procedure is accompanied by heavy bleeding and severe spastic pain in the lower abdomen. In addition, it is less well tolerated psychologically. Sometimes, after these drugs, surgical intervention is still necessary,” adds obstetrician-gynecologist Elena Mladova.
“There is no safe abortion; this term is misleading, including gynecologists,” says gynecologist Maria Menshikova from Teledoctor24. According to her, the assertion that medical abortion is less harmful than surgical or vacuum abortion is not sufficiently substantiated.
«No one knows how this will end for the patient, what column of statistics she will fall into. Statistics are needed for planning , understanding the prospects, but not for advertising a dangerous procedure,” the doctor clarifies.
Menshikova compares medical abortion to Russian roulette: “either there is a complication or there is not.”
There are practically no generalizing long-term scientific observations of the consequences. Two years ago, specialists from the Charlotte Lozier Institute analyzed the statistics of abortion clinics for the period from 1999 to 2015. It turned out that after a chemical abortion, an ambulance was called more often than after a surgical one. Now, citing these results, human rights activists are trying to challenge the approval of RU 486 in the United States in court.
As Medvestnik writes with reference to the chairman of the Patriarchal Commission on Family Issues, Protection of Motherhood and Childhood, Priest Fyodor Lukyanov, the statistics of abortions in Russia may be greatly underestimated — due to unaccounted for medication cases. About 72 percent of these procedures are performed in private clinics, the reporting of which is not transparent. According to RNC Pharma, 1.4 million chemical abortion drugs were purchased last year—60 percent more than in 2021. This gives an approximate idea of the volume of gray services.
Recently, the Ministry of Health updated Order No. 459n “On approval of the list of medicines for medical use, subject to subject-quantitative accounting,” which also included drugs for abortion. According to Minister Mikhail Murashko, this will reduce the number of abortions. Natalia Dolgushina, the chief freelance specialist on women's reproductive health at the Ministry of Health, also believes that tightening control is justified.