Microsoft word - home_abortions_ story by marianna grigoryan_eng
“NOT STUDIED BUT A MATTER OF CONCERN: ARMENIA SEES A DISTURBING GROWTH OF SELF- INDUCED ABORTIONS”
Despite being young, Lilit Harutyunyan says “her life is over” and “she will never forgive herself.” “If I only knew what would happen, I would not go that far. I thought if I didn’t remove the child, I would be embarrassed in front of the whole city,” Lilit, 20, a habitant of one of the Armenian small towns, says in tears. She tells that she was in a dead-end situation, when she made the decision of ending her pregnancy of two and a half months. She could not tell her patents about this, since she was not married, and her boyfriend had disappeared at the very moment when he knew about the baby. On the advice of one of her experienced friends, Lilit bought Cytotec from the drugstore and tried to end her pregnancy at home. “I didn’t want to, but I had no choice… I took a handful of Cytotec, then I started bleeding heavily, and felt how I was loosing my child … The whole bathroom was in blood, my parents were in panic, since they didn’t know what was going on … My mother fainted. The bleeding did not stop, and the doctors had to remove my uterus for saving my life. I will never have a baby…,” Lilit is telling. Health care specialists say that in the past many women resorted to all possible and impossible methods to terminate the unwanted pregnancy - jumping from the closet, inserting different objects and pipes in the uterus, taking quack-prepared unknown herbal mixtures. Meanwhile, in the recent years the number of abortion inducing drugs has raised in Armenia. Specifically Cytotec - the misuse of which can become a real disaster for a woman - holds a leading position. RA Chief Obstetrician-Gynecologist Razmik Abrahamyan mentions that self-induced medical abortions made with low level of awareness, are “one of the main issues of the Healthcare Ministry”. “Medical abortions are less dangerous, than surgical ones, in case if they are performed properly and legally,” - Abrahamyan reports to Medialab. “However, it is dangerous, when women try to terminate their pregnancy with no prior medical consultation, for example with the help of Cytotec. In this case, adverse effects, bleeding may happen and everything is possible.”
According to pharmacist Hrant Papikian, in reality Cytotec is used for the prevention of gastric ulcers. At the same time, being contradicted for pregnant women, it increases uterine contractions, which in its turn may cause abortion. Nevertheless, specialists note that using Cytotec in wrong doses, or its misuse - even in small doses - for abortion purposes may not only cause heavy bleeding and irrevocable health issues, but may also cost the woman her life. “You see Cytotec is a strong drug, but in Armenia people have no idea about it and they take, like 16 pills, at once . This is why we have even stated some death cases. Every day, they bring girls and women with inner bleeding, whose life we save just barely," obstetrician-gynecologist Arpine Soghoyan, Head of Women’s Consultation Department of Kanaker- Zeytun medical center reports to Medialab. Doctors assert that several issues induce Armenian girls and women to use unknown and dangerous abortifacient methods - the Armenian conservatism, which leads to self-induced abortions among girls who are in extramarital relations, the desire of quickly removing the unwanted baby, social insecurity, insufficient access to medical services, etc. Representatives of regional hospitals tell that they are aware of the issue. They say that nowadays more women prefer to terminate a pregnancy by taking a pill of Cytotec, which is “cheaper and more accessible” - one pill costs 160-200AMD- rather than performing an abortion at the hospital, which costs 15.000-20.000 AMD. Nelly Mirzoyan, Head of Obstetrician-Gynecology Department of Vanadzor Medical Center CJSC, assures that the majority of women, who are transferred to the hospital with "heavy bleeding", are those who had attempted self-induced abortion. "In very rare cases traditional or medical at-home methods of abortions succeed. As a result, we receive women with miscarriage and in grave health condition,” Mirzoyan says. Despite the widespread concern, no study on the rate of self-induced abortions exists in Armenia, Gayane Avagyan, Head of Mother’s and Reproductive Health Safety Service of the Child and Mother’s Health Care Department of RA Health Care Ministry, tells Medialab. However, the specialist adds that Armenia has seen a positive decrease in the abortion rate for the last five years. This positive trend is also witnessed in the “Armenia Demographic and Health Survey 2010”, conducted by the joint efforts of the RA National Statistics Service and RA Health Care Ministry. "In the three years preceding the survey, 63 percent of pregnancies resulted in live birth, while 29-in abortion. Since 2005, when 45 percent of pregnancies ended with abortion, this indicator has dropped significantly," mentions the study. The same study states in almost numerical figures: “57 percent of the abortions was performed through surgical intervention, and the 39 - through vacuum aspiration.” However, the study does not mention anyhow about medical abortions. Meanwhile, by an amazing coincidence, the drop in abortions is directly linked to the period, when Cytotec was introduced in the Armenian market. Even though the official response of the Health Care Ministry, provided to Medialab, stresses that "Cytotec 200 mg" drug, produced by "Piramal Healthcare UK Limited" UK company, was registered in Armenia on December 7, 2009, the surveys, made by Medialab, show that in different regions of Armenia, Cytotec was available at some drug stores since 2007, yet unregistered. The most vivid evidence for this is the April 2007 communication of RA Police, which reported about the death of a woman, caused by self-induced abortion with the help of Cytotec. Mari Avanesyan, Yerevan, first contacted with Cytotec back in 2007. She tells that five years ago in December, on the advice of a medical employee, she bought Cytotec for abortion purpose in a drugstore on Komitas street. She reports that even though she had no pains when taking the pills of
Cytotec, she was transferred to one of the hospitals with heavy bleeding, where the doctors provided medical aid, without making any record about the patient. “My two friends have tried to remove their child with the help of Cytotec in different times. One of them fully succeeded in this, but the other, just like me, had some issues and had to visit a doctor. No matter the adverse effects, many people know about Cytotec and use it, on each other’s advice,” Mari Avanesyan says. Meri Khachikyan, Head of "For Family's and Mother's Heath" NGO, has been engaged in reproductive, sexual and other health issues for many year. She casts on doubts on the statistics and the drop of abortions, taking into account the current situation. "Those numbers don't reflect the real picture, since, for example, medical abortions mostly remain unrecorded. Even if the misuse of drugs leads to adverse effects and the woman visits a doctor, the treatment is done without making any record, paying any state duties and any noise," says Khachikyan. It is worthwhile that along with these unrecorded cases there is an annual increase in the import of Cytotec. According to the data of the Ministry of Health, provided to Medialab, for example, in 2010, the official import of “Cytotec 200mg" made 2500 packs, in 2011 - this rate was ten times more, yielding 26.655 packs. According to the mini-surveys administered by Medialab at different Armenian drugstores, the demand for Cytotec is growing every year, and the buyers are mainly young women and girls. However, without any valid study it is impossible to say why women of reproductive age buy the drug. For investigating the real reasons and having a projection on the abortion rates, a thorough study is needed, thinks Garik Hayrapetyan, Deputy Head of the UN Fund of Population in Armenia. But even without this, he stresses a discrepancy in the official statistics: according to the “2010 Study on Demographic and Health problems in Armenia”, in 2005-2010 the rate of abortions in Armenia has decreased more (16 percent) than the rate of contraceptives’ use has increased (7 percent). Thus, it is natural that the birth rate should have increased. However, the reality shows that neither the birth rate nor the infertility percent have increased. "Then where are the unperformed abortions? Either people don't make sex, or the abortions are not recorded anywhere, and most probably this refers to medical abortions," Hayrapetyan says. RA Chief Obstetrician-Gynecologist Razmik Abrahamyan admits that the rate of self-induced medical abortions is becoming disturbing. "The Ministry is considering options to remedy this problem. Some control should be undertaken, the drugs should be sold upon prescription, and abortions should be made only with the help of obstetrician-gynecologist at hospitals," Abrahamyan says. Marianna Grigoryan Names of the story heroes are changed. Lilit Arakelyan and Anush Bulghadaryan have contributed to the investigation. This investigation is done with support from the Danish Association for Investigative Journalism/Scoop.
Improving Bioscience Research Reporting: The ARRIVEGuidelines for Reporting Animal ResearchCarol Kilkenny1*, William J. Browne2, Innes C. Cuthill3, Michael Emerson4, Douglas G. Altman51 The National Centre for the Replacement, Refinement and Reduction of Animals in Research, London, United Kingdom, 2 School of Veterinary Science, University ofBristol, Bristol, United Kingdom, 3 School of Biol
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