الأربعاء، 6 يونيو 2018

100 Women: The modern face of the 'DIY abortion'

100 Women: The modern face of the 'DIY abortion'
Hand over tablet computerImage copyrightGETTY IMAGES
Global online searches for abortion pills have more than doubled over the last decade, BBC analysis of Google searches shows.
The findings also suggest that in countries where abortion laws are more restrictive, there is greater search interest in abortion pills.
By buying pills online and sharing medical advice through WhatsApp groups, women are increasingly turning to technology to sidestep legal barriers to abortion.
This is the modern face of the so-called "DIY abortion".
Countries with the strictest laws, where abortion is allowed only to save a woman's life or banned altogether, have over 10 times higher search interest in abortion pill Misoprostol compared to countries with no restrictions, BBC analysis shows.
There are two main methods of inducing abortion; surgical and medical.
Chart: Search interest in Misoprostol, 2004-2018
A medical abortion typically involves taking a combination of pills, Misoprostol and Mifeprostone, to induce a miscarriage. Misoprostol can also go by brand names like Cytotec.
While women in countries such as the UK will be prescribed this combination by a doctor, women searching for and purchasing the pills online in countries where access to abortion is restricted are often breaking the law, risking severe punishments.
Ghana and Nigeria are the two countries with the highest search interest in Misoprostol, according to the Google data.
Ghana only allows abortions in cases of rape, incest, foetal impairment or to preserve a woman's mental health.
Nigeria is stricter still: abortion is only allowed in situations where a woman's life is in danger.
Of the 25 countries with highest search interest in Misoprostol, 11 are in Africa and 14 in Latin America.
All but two - Zambia and Mozambique - either ban abortions altogether or allow them only to save a woman's life or health.
The taoiseach (prime minister) Leo Varadkar, who campaigned in favour of liberalisation, has said he hopes new rules will be in place by the end of the year.
Map: Legal access to abortion by country
Map: Searches for abortion pills by country
The BBC recently reported on a WhatsApp group, operating in Brazil, helping women get hold of the pills and offering them advice during the procedure.
Juliana (not her real name) was one of the women who sought the WhatsApp group's help.
"I did the procedure alone at my house and reported the time I was going to start to the WhatsApp group," says the 28-year-old.
"What I thought was really nice, is how the other women in the group help each other, sharing information, and discussing doubts and fears. This strengthened me, in a way.
"It's always good to know that you're not alone. The group was very important to me, for me to feel safe."
Media captionInside the secret world of Brazil's WhatsApp abortions
Analysing Google data doesn't just show the countries where search interest is highest. It can also show how often exact phrases are searched about a topic.
"Abortion pills" is a top search phrase on abortion in all the countries analysed by the BBC.
"How to abort" is the most commonly asked question in more than two-thirds of countries.
"How to use Misoprostol", "Misoprostol price", "buy Misoprostol" and "Misoprostol dosage" feature among the most common searches around abortion.
Chart: Search interest is higher where laws are stricter
Alongside abortion pills, women are also turning to their search engines to source alternative methods to self-induce abortions.
Herbs like parsley, cinnamon, vitamin C, aspirin and abortion teas (herbal concoctions) all came up as top searched methods.
In half of the countries we looked at "home remedies for abortion" was a top search related to abortion.
Along with a lack of data around safety, the study suggested it was hard for practitioners to control dosage and side-effects.
None of the "home remedies" listed above are considered safe abortion methods by the World Health Organisation.
Pro-abortion campaigners in Argentina, holding signsImage copyrightGETTY IMAGES
Image captionAbortion is high up the political agenda in Argentina at the moment, with people taking to the streets to campaign on both sides of the issue
Worldwide, about 25 million unsafe abortions take place each year, according to the World Health Organisation, accounting for 45% of all abortions.
These 25 million unsafe abortions are categorised even further.
Although Misoprostol is normally considered a safe method of abortion when administered by a medical professional, when it is used by an untrained person it poses risks.
When it is administered by an untrained person, the World Health Organisation classes it as "less safe" and says this accounts for almost one-third (31%) of the total number of abortions, both safe and unsafe.
"Even when the quality of the drugs is perfect and you follow the protocol to the letter, there is still a failure rate," says Dhammika Perera, the global medical director at Marie Stopes International.
When a woman buys the pills online, or is provided them by an untrained person, it increases the chances of a failed abortion, he says.
These women are also less likely to go for post-abortion care if something goes wrong.
"Stigma, cost, geographical access can all make women hesitate and that puts them at risk," Mr Perera says.
"It's slow progress, but that there is progress, is unquestionable.
"Globally some backward steps have been taken, in the US for example, but I remain hopeful."
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The BBC recently heard the story of Arezoo, a law student, who was living in Iran when she found out she was pregnant by her boyfriend of five years. They had always used contraception.
"Every gynaecologist's office I saw I walked in," she says.
"When the doctors checked me and found out I was unmarried and needed an abortion they rejected me immediately."
She faked documents suggesting she was divorced and convinced a doctor to help her.
"He charged me an arm and a leg for eight pills," she says. But the medication had no effect.
Arezoo went online and came across a charity that sends abortion pills to women in countries where the procedure is restricted. There she received advice and support.
Ultimately the pills she got from the doctor made her bleed heavily but the abortion was not completed and Arezoo was rushed to a private hospital a week later accompanied by her sister.
"I lied, I told them my husband was in France and that my documents were in a safe somewhere and I needed to have a safe abortion."
Hospital staff were reluctant and didn't want to admit her.
Arezoo says it was a miracle that they finally gave in and believed her.
"After all that lying and making up stories, I was finally admitted and thirty minutes later the suction procedure was done. It was the worst nightmare of my life," she says.
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About 14% of all abortions were "least safe", which means they were provided by untrained persons using dangerous methods, such as the introduction of foreign objects and use of herbal concoctions.
Complications such as infection and incomplete abortion can arise from these methods.
When an abortion is incomplete, medical professionals may either advise further medication, or a surgical option, depending on the situation.
At least 22,800 women die each year from complications of unsafe abortion, the Guttmacher Institute reports.
Reporting by Amelia Butterly and data journalism by Clara Guibourg. Additional reporting by Dina Demrdash, Nathalia Passarinho and Ferenak Amidi.
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Methodology:

All search data used covers the last five years and comes from Google Trends, which doesn't provide exact search volumes, but relative search interest in a topic from 0-100, where 100 is the highest search interest for the given topic, time and geography. Searches made in different languages or using different names for the medication (e.g. "abortion pill", "Misoprostol" or "Cytotec") are all included in the data.
We looked at global search data for the overall trends, and looked at 14 countries in more detail: Ghana, Nigeria, Honduras, Bolivia, Ecuador, Nicaragua, Kenya, Mexico, US, Colombia, Brazil, Argentina, India, and Ireland. The data on abortion laws for each country is from the Center for Reproductive Rights.

Pomegranate contamination kills woman in Australia

Pomegranate contamination kills woman in Australia
A cut pomegranateImage copyrightEPA
Image captionAustralian authorities have linked 24 hepatitis A cases to a frozen pomegranate product
An Australian woman has died after contracting hepatitis A from a packet of frozen pomegranate.
The 64-year-old died in South Australia last week in a "rare and tragic" case, state health authorities said.
Local officials issued a warning about the Australian-owned Creative Gourmet product in April. It has been linked to 24 cases of hepatitis A nationally.
Australians have been urged to check their freezers and discard packets of the frozen fruit.
About 2,000 packets of the Egyptian-grown pomegranate arils were sold. Fresh pomegranate and locally grown products were not affected, authorities said.
"The woman's death is the only death linked to this recalled product nationally to date," South Australia chief medical officer Prof Paddy Phillips said.
Most other people affected had made a full recovery and no further cases were expected, he said.
Hepatitis A, which attacks the liver, is usually spread through faecal matter, transmitted through sex or by touching contaminated food or objects.
It typically takes between 15 and 50 days to develop symptoms, which include nausea, fever and yellowing of the skin, local health authorities said.
Entyce Food Ingredients has said the contamination was linked to a "a relatively small batch" of its product.
Last year, the company was also forced to pull a selection of its frozen mixed berries products following another hepatitis A outbreak.
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Syphilis and gonorrhoea up by one-fifth

Syphilis and gonorrhoea up by one-fifth
CondomsImage copyrightGETTY IMAGES
England has continued to see a rise in cases of syphilis and gonorrhoea over the past year.
New data shows a 20% increase in cases of syphilis and a 22% increase in gonorrhoea, compared with 2016.
Diagnoses of sexually transmitted infections (STIs) in England remain stable overall, with around the same number reported as the previous year.
Health experts have expressed concern over a decline in testing for chlamydia.
Graph showing rising rates of syphilis and gonorrhea
The impact of STIs remains greatest in young people aged between 15 and 24 years, with gay, bisexual and other men who have sex with men among those most at risk, says Public Health England in its report.
Black and minority ethnic populations are also disproportionately affected by STIs.
Chlamydia remains the most prevalent of the diseases, accounting for more than 200,000 cases last year - nearly half (48%) of all new STI diagnoses in 2017.
Testing in contraceptive clinics has fallen by 61% since 2015, which experts say may indicate a squeeze on resources. However, it may also reflect a rise in the use of home testing kits - and the availability of testing in other settings.
More than 7,000 cases of syphilis and nearly 46,000 cases of gonorrhoea were reported to Public Health England in 2017.
Secondary syphilis rash and inflammation on a backImage copyrightSCIENCE PHOTO LIBRARY
Image captionThe rise in syphilis is part of a 10-year trend
The rise in syphilis follows a 10-year trend, with three-quarters of new diagnoses in gay, bisexual and other men who have sex with men.
Health professionals have expressed concern at the rise of gonorrhoea and the threat of super-gonorrhoea, a rare but emerging strain that is resistant to routine drug treatment.
In March, the first case of super-gonorrhoea was detected in the UK, in a man who is thought to have caught the infection having sex abroad in South East Asia.
Two "similar" cases were subsequently discovered in Australia, suggesting that super-gonorrhoea may become more common in the future.
Debbie Laycock, from the Terrence Higgins Trust, said: "Our sexual health services are stretched too thinly and demand outweighs availability, with more cuts already planned.
"The significant rise in both syphilis and gonorrhoea shows why further cuts are completely unacceptable and would be extremely damaging, particularly given the emergence of a new extensively drug-resistant strain of gonorrhoea."
Meanwhile, a significant fall in rates of genital warts - a 90% decrease on 2009 - reflects the widespread take-up of the Human Papilloma Virus vaccine in girls aged 12-13.
Last December, Public Health England (PHE) launched a sexual health campaign aimed at promoting condom use among young people.
Dr Gwenda Hughes from PHE said: "Consistent and correct condom use with new and casual partners is the best defence against STIs, and if you are at risk, regular check-ups are essential to enable early diagnosis and treatment."