Mifeprex in Nepal

Dear ProLife Colleague, We have often mentioned the huge emphasis on reducing maternal mortality, and especially so for the underdeveloped countries where maternal mortality may be up to 100 times higher per delivery than in the US. And AAPLOG is all in favor of reducing maternal mortality. But on an international level, the thinking goes like this: If less women come to term, this will certainly decrease the number of maternal deaths. If there is more access to legal abortion , there will be less pregnancies coming to term, thus less birth related mortality. Wow! What a success story that will be. But there are not enough qualified professionals who are trained in surgical abortion methods in underdeveloped countries. Enter: the abortion pill. One does not have to be trained in surgical procedures to give the abortion pill. One only need to be able to count up to 9. What a wonderful solution. “Midlevel professionals” (nurses) can give the abortion pill. There will be less pregnancies coming to term, and less maternal deaths. Sounds like a winner all around. In Nepal, certified nurses and auxiliary nurse midwives performed abortions at up to 9 weeks’ gestation with similar safety and efficacy to the performance of physicians, according to a study published online March 31 in The Lancet. The study claimed 96% complete abortions, not requiring suction or D&C. This is phenomenal. Too good to be true, well maybe actually too good to be true. Consider this: In the USA Clinical Trials with Mifeprex, taking screened candidates, each getting an ultrasound, at 7 weeks there was an 8% D&C rate for heavy bleeding; at 8 weeks, 17% D&C rate; and at 9 weeks, a 23% D&C rate. That is from US clnical trials. And in Nepal, a zero percent D&C rate? Something smells a little fishy here. Makes for great stats, though. We will try to scope this out a bit further, and report to you. Meantime, given what we know about the need for D&C for heavy bleeding after Mifeprex in the US Clinical Trials: What will happen to those women who bleed heavily in a country with very limited medical infrastructure? Many will bleed to death. Or they will become infected with retained products of conception,, and many will die of sepsis in the village, or jungle, or ghetto. But magically, they will NOT appear on the maternal mortality statistics. They will just die and be buried. After all, in 3rd world settings, women bleed and become septic and die all the time. No unified data base is kept on them, it’s been going on since the beginning of time. So they won’t be counted. And less women will come to delivery, and less women will die in delivery. And the bean counters will chalk up impressive success numbers for decreasing maternal mortality, further validating use of the abortion pill. This is progress? This is happening. Jdc/aaplog