In the past, to get rid of unwanted pregnancies, Armenian women used to jump off wardrobes, insert pipes into their uteruses or drink various “potions.“ Now, they often just purchase Cytotec, a preventive medication for stomach ulcers that can induce abortions, and try to carry out the procedure themselves at home.
Women’s healthcare specialists believe that a 16-percentage-point decline in clinical abortions in Armenia since 2007 is linked to women using Cytotec for such “do-it-yourself” abortions rather than having a surgical procedure in a hospital.
A 2010 survey by the Armenian Ministry of Health and National Statistical Service of 5,922 women between the ages of 16 and 40 years old found that 29 percent of the respondents’ pregnancies for the past five years had ended in a hospital abortion.
By comparison, in 2005, 45 percent of the respondents’ reported pregnancies were terminated this way.
But no corresponding increase in the birth rate, sterility rate or use of contraception was reported.
“So, where are these ‘no-abortions’? Either people no longer are having sex or these [abortions] are not being registered,” commented Garik Hayrapetian, an assistant representative at the Armenian office of the United Nations Population Fund. “The reason perhaps lies in pill abortions.”
“Pill abortions,” as they are called, refer to abortions induced by Cytotec, a product of the American pharmaceutical company Pfizer, which, when misused, can cause uterine contractions, bleeding and miscarriage in pregnant women. In the United States, Cytotec is available only by prescription; a contraindication exists for pregnant women.
Armenia, however, has no such restrictions; 200-microgram tablets of Cytotec have been sold over the counter in pharmacies since 2007, several Yerevan pharmacies told this reporter as part of an investigation for MediaLab.am funded by SCOOP, an international network of investigative journalists.* (Official records indicate imports began in late 2009, however.)
The period largely coincides with the time frame for the 16-percentage-point decrease in registered abortions reported by the government.
One obstetrician-gynecologist at the medical center in Vanadzor, the country’s third-largest city, said that most cases of “extreme bleeding” that she sees are related to an attempt to abort a fetus at home.
“In very rare cases, home interventions with the use of drugs or other methods have a lucky ending,” said Dr. Nelly Mirzoian. “Usually, we have women bleeding with an incomplete abortion, in a dangerous situation.”
Doctors in Yerevan hospitals echoed that finding. “Cytotec is a strong medication, but [women], being poorly aware of this, just take the pills …That’s why we’ve had several fatal cases,” said obstetrician-gynecologist Arpine Soghoian, head of pre-natal medicine at Yerevan’s Kanaker-Zeytun medical center. “Women are routinely brought into hospitals with internal bleeding, and we try hard to save their lives.”
Often, said the Ministry of Health’s chief obstetrician-gynecologist, Razmik Abrahamian, women rely on the advice of their neighbors about using Cytotec and, pressed for cash, do not consult a doctor. “In this case, complications may arise; a hemorrhage can take place. Anything can happen.”
No official data exists on the number of Cytotec-related fatalities nationwide. In 2007, the medication was cited as the cause of death for 37-year-old Armine Danielian, a Yerevan resident who took a Cytotec pill to terminate a pregnancy.
Little indication exists that such risks have decreased demand for Cytotec. According to data from the Ministry of Health, the amount of Cytotec imported into Armenia increased by more than 10 times between 2010 and 2011, to 26,655 packs of 200 micrograms.
Fifteen pharmacies in Yerevan and 10 regional pharmacies told MediaLab that most purchasers of Cytotec tend to be women between the ages of 16 and 40.
Those who have used Cytotec to induce abortions often cite financial constraints as the cause.
Surgical abortions tend to cost, on average, 15,000 to 20,000 drams ($35 - $50) in hospitals; Cytotec pills cost 180-200 drams (40-50 cents) per 200-microgram pill. In a country where monthly incomes may be as little as $440, that difference, for many, is substantial.
Other women who have used the pill cite a desire to avoid the strong social stigma that exists in Armenia’s traditional culture against women who have children out of wedlock.
A 20-year-old woman from one small town told EurasiaNet.org a friend had advised her to use Cytotec at home to end a pregnancy from an extramarital relationship. An emergency-room hysterectomy was required to stop the bleeding that resulted and to save the woman’s life.
The whole town became aware of her situation, said the woman, who requested anonymity, who described her future, now that she is unable to bear children, as "ruined.”
For ways to end such abuse of Cytotec, most specialists look to the government. They cite the need for a formal study into home abortions, and call for a requirement that the medication be available by prescription only and that abortions take place only in hospitals.
Said Chief Obstetrician-Gynecologist Abrahamian, “There must be control over this . . .”
----*The Open Society Foundation is among the organizations which have provided financial assistance to SCOOP. EurasiaNet.org is operated under the auspices of the Open Society Foundation's Central Eurasia Project.
Marianna Grigoryan is a freelance reporter in Yerevan and the editor of MediaLab.am.