Sunday, 09 January 2011 By Sharifa Kalokola Abortion pills are easily available in the pharmacies and retail drug outlets at an astonishingly affordable price of Sh2000. The Citizen on Sunday managed to buy the pills at one of the drug shops in Mwenge area in Dar es Salaam during the week. The seller looked at me in the eyes for a few seconds, then went to the storeroom and handed them to me. "There you are," she said without asking for a prescription, as she gave them to me as if I knew what to do with them. After pushing her hard on instructions for usage the seller claimed that for the case of abortion it can be carried out at home within the first nine weeks of pregnancy. Then, I asked for receipts, and she quipped, "I give no receipts for these drugs because they are prohibited to be sold without a doctor' prescription." They are misoprostol drugs, also known as cytotec. The drugs are artificial steroid hormones, which interferes with early progress of pregnancy and discharges the embryo. Misoprostol was registered in Tanzania in 2007 as a drug to stop postpartum hemorrhage (PPH), which is referred to as blood loss in excess of 500ml following childbirth. Apparently, it is apparent that many women who cannot afford having abortion, which is expensive, life threatening, and illegal are using the pills clandestinely to end pregnancies. However, the major concern is that taking these drugs without prescription may bring fatal side effects to the mother. According to health professionals, they are known to cause severe bleeding, devastating damage to the foetus and, in some cases, abdominal pain, convulsions (seizures), diarrhea and drowsiness. The World Health Organization (WHO) warns that misuse of misoprostol by pregnant women, or those who care for them, may cause disastrous consequences if taken at the wrong time or dose. WHO insists that the drug needs further safety studies as it may prove to have serious side effects. In a simple search for abortion pills in the retail drug outlets in Dar es Salaam, more than three sellers gave the life-threatening pills without prescriptions at all, while only one said that a doctor's recommendation was needed to make the purchase. Some of the drug shops, particularly the so-called maduka ya dawa baridi (MBDs), which are the most widespread source of medicines for purchase in the country, are authorized by the Tanzania Food and Drugs Authority (TFDA) to dispense nonprescription medicines only. TFDA acting public relations officer, James Ndege said that abortion drugs were not supposed to be sold at the ordinary MDBs simply because they are prescription medicines. "Misoprostol is not supposed to be sold in the retail drug stores since it is in the category of prescription medicines. And if sold in pharmacies, it has to be given under a doctor's recommendation," he said. According him, the authority has realized the misuse of MDB licences and there is an on-going strategy to tackle the problem. "The misuse of the drugs is common in our community. It is not only misoprostol which is misused but many other drugs too," he says. An assessment by TFDA in 2001 revealed that the drug shop's dispensing staff generally lacked basic qualifications and training and often sold prescription-only medicines illegally, and in addition, the shops had little regulation enforcement or supervision. Ndege said that TFDA had already come up with an-ongoing program of using accreditation and regulation to improve dispensing and use of medicines in retail drug shops. Under the program, the MDBs are to be changed to Accredited Drug Dispensing Outlets (ADDO). Moral values Ndege says that the misuse of drugs has nothing to do with the authority's poor supervision but the community's attitude in general. "Abortion is illegal in Tanzania. The drugs were not registered for such purposes," he says. A gynecologist, Dr Progestine Muganyizi, who is also the president of association gynecologist in Tanzania, says it is doctors who do not follow work ethics and prescribe the drug for abortion. He said the drug, apart from being used for PPH, is also used for post abortion care in case of miscarriage or incomplete abortion. He urges that doctors to observe their work ethics since abortion is illegal in the country. Abortion Since abortion is illegal, some countries see misoprostol as a moral danger despite its potential benefits. The Philippines, for example, has banned it. However, unsafe abortions account for 13 per cent of maternal deaths globally. Worldwide, there are 19 million unsafe abortions a year, resulting into 70,000 deaths of women (13 percent of maternal deaths), mostly in poor countries like Tanzania where the practice is illegal, according to the WHO. Reliable figures on abortion in Tanzania are hard to come by, but WHO reports that Eastern Africa has the world's second-highest rate of unsafe abortions. And Africa as a whole has the highest proportion of teenagers (25 percent among women) having unsafe abortions. Safe-motherhood Despite being misused, misoprostol is a medication with magical properties, which are undeniably beneficial. PPH is the leading cause of maternal mortality in Tanzania and across the globe, commonly due to lack of affordable and accessible medical care. That is the reason why the drug has been recommended by WHO for prevention of PPH. This June at the 2010 Women Deliver Conference held in Washington, DC, new technologies to save and improve mothers' lives were highlighted, including the use of misoprostol tablets as an effective method to prevent bleeding after childbirth. The three-day conference brought together over 3,000 policymakers, women's advocates and health care professionals from over 115 countries. In Tanzania many mothers deliver their babies at home with the help of a family member or traditional midwife. But the risk of hemorrhage, which is the leading cause of maternal death, remains high. Maternal mortality in Tanzania currently stands at around 400 deaths for every 100,000 live births. But these deaths are preventable, according to gynecologist Muganyizi He says that a solution may come in the form of simple, affordable and easy-to-use tablet--- misoprostol. "When a mother takes three life-saving tablets of misoprostol immediately after the baby is born, it can effectively prevent excessive bleeding," he says. And the preventative dose is astonishingly at low price.