Over-the-counter sales of Cytotec, an anti-ulcer medication, are continuing in Armenia despite an August-1 ban intended to prevent women from using the drug to abort unwanted fetuses at home.
The government claims that compliance with the ban will come with time, but, so far, officials do not appear to be taking measures to ensure that pharmacists ask those purchasing Cytotec to show a prescription.
Since the ban went into effect on August 1, a EurasiaNet.org correspondent visited 27 drugstores in the Armenian capital, Yerevan, and its outskirts, and was able to buy Cytotec pills in 20 of them without a prescription. “We have no information about the ban,” claimed an employee at one popular pharmacy in the Yerevan suburb of Malatia-Sebastia.
At another drugstore, a pharmacist stated that Cytotec “is currently unavailable,” but suggested two related, Russian-made drugs as substitutes not requiring a prescription: Mirolute, which contains misoprostol, the active ingredient in Cytotec; and Miropristone, which contains mifopristone, the active ingredient in what is known internationally as “the abortion pill.” Misoprostol and mifepristone are often used together for medical abortions, and are obtained for that purpose via prescription in the European Union and United States. Users for medical abortions also receive professional counseling.
That tends not to be the case in Armenia, however. In Yerevan and elsewhere, the medications often are handed out like aspirin and come without any form of advice about dosage from a pharmacist or medical professionals.
Both drugs, misoprostol and mifepristone, could be purchased over-the-counter in 25 of the 27 pharmacies visited by EurasiaNet.org. None of the pharmacists stated that the two drugs should be used together.
The Malatia-Sebastia pharmacist added, however, that “we always warn young women, who mostly are the ones buying [Cytotec, Mirolute and Miropristone], that they should use the medication with caution.”
The Ministry of Health appears divided over which of these medications actually now have been banned from sales without a prescription. Chief-of-Staff Armen Karepetian told EurasiaNet.org that the August-1 ban applies to Mirolute and Miropristone, as well as to Cytotec. But Dr. Razmik Abrahamian, head of the ministry’s Center for Perinatology, Obstetrics and Gynecology, said that the ban on over-the-counter sales would apply to the two Russian medicines only if they become as popular as Cytotec for at-home abortions.
The United Nations Population Fund (UNFPA) has attributed a dramatic decrease in Armenia’s official abortion rate from 2005 and 2010 (from 40 percent to 28 percent of child-bearing-age women) to the use of drugs for do-it-yourself abortions.
Abrahamian, who holds the title of Armenia’s chief obstetrician-gynecologist, said patients suffering complications from the misuse of Cytotec occur weekly. “We had cases with women who took Cytotec pills and had no idea about its dosage. They underwent long treatment in the intensive care unit, with blood transfusions,” he recounted.
Nonetheless, he is not unduly alarmed by the fact that Armenian pharmacies continue to sell this medication over-the-counter to women in search of a cheap and relatively safe abortion option. “Many drugstores have not received the instructions [about no over-the-counter sales] yet, or they do not follow them. It takes time to implement control effectively,” he said.
Very little in the way of control exists. Pharmacies are required to keep records for three months of all their purchases and sales, but no mechanism appears to exist for a government-review of these records for improper sales of Cytotec. For many women, hard-pressed for cash, Cytotec’s attraction is its cost. One 200-microgram tablet costs about 200 drams (about 50 cents), while an abortion in a hospital costs 100 times more – about 20,000 drams or $50.
For many women in Armenia, using the medication for an abortion appears to be by trial and error. At the same time, pharmacies are plainly aware of why many women are buying the anti-ulcer drug, which is made by the global pharmaceutical giant Pfizer. “Women take a different number of pills depending on the information they have” from their friends or relatives, commented the employee of a drugstore in Yerevan’s Arakbir neighborhood. “Sometimes, after an unsuccessful attempt they come back and buy the pill again.”
Surveyed drugstores, aware of Cytotec’s popularity, do not appear to hesitate about selling a second dose without a prescription. The risks can be severe for purchasers.
Ten days after the ban on over-the-counter sales of Cytotec went into effect, one 36-year-old Yerevan woman, following her friends’ advice, purchased eight 200-microgram tablets of misoprostol, the generic form of Cytotec, from a drugstore to try and end her six-week pregnancy at home. The attempt brought on heavy hemorrhaging and an emergency trip to the hospital to complete the abortion.
“Probably I used the medicine incorrectly,” the woman, who asked not to be named, told EurasiaNet.org. “The drugstore staff said complications might occur, but I never thought I would be so close to death.”
Given the present circumstances, the UNFPA sees Armenia’s official ban on over-the-counter sales of Cytotec as a positive development, despite the difficulties. “[W]e hope the situation will change for the better in the future,” commented UNFPA Armenia Assistant Representative Garik Hayrapetian.
Marianna Grigoryan is a freelance reporter based in Yerevan and editor of MediaLab.am.