When Abortion and Life Cross Paths in Drugstores

Termination of pregnancies – the use of the abortion pill seems to have gotten out of control, endangering lives of girls and women on a daily basis, and seriously harming their reproductive health.

Klaudja Karabolli

Klodjana B. was bleeding profusely for six hours in a row, while she was home alone and had no one around to ask for help. 20-year-old Jonada H. collapsed after vomiting several times over the course of more than two hours.

Viola D. woke up terrified the third morning, with the same fever as the previous two mornings, even though she had tried all kinds of medications and remedies to bring the fever down.

Arisa Y. was 23, when she went into shock and collapsed after copious blood loss and high fever, while she was waiting for her girlfriend to get her to the hospital.

These four girls tell PSE that they suffered those health complications after they had tried to abort by ingesting abortion pills they had bought in pharmacies, without consulting a doctor and without any medical advice.

Lives of women and girls are seriously endangered by this intolerable practice, and in many cases they suffer irreversible consequences to their reproductive health.

An investigation by PSE revealed that even though the sale of such pharmaceuticals in pharmacies is officially prohibited, they are readily available to customers. Thousands of girls and women are believed to have carried out pharmaceutical abortion, or medical abortion, without any assistance from doctors and health care institutions, by purchasing abortion pills in neighborhood drugstores with the same ease they would buy an aspirin.

This investigation revealed that abortion pills were readily available without any doctor’s recommendation or picture ID in 10 pharmacies in Tirana, out of a sample pool of 30 drugstores, where we asked to buy such pharmaceuticals.

This result may induce one to believe that the same thing probably happens in hundreds of pharmacies all over Albania; all the while the National Agency of Pharmaceuticals maintains they are not aware that such a problem exists.

Also, the Ministry of Health has shown a lack of interest in pursuing this issue, by leaving the fate of scores of women and girls at the hands of unscrupulous pharmacists.

Official data show that the number of abortions in Albania is on the decrease, but in truth the only thing that has decreased is the number of abortions that are performed in specialized health care centers.

However, there is a whole other parallel reality outside the purview of health care institutions.

Medical abortion, a situation gone out of control

Abortions lead many girls and women to pharmacies and not to the doorsteps of hospitals and medical clinics. Obstetricians and gynecologists are the first ones to admit that this is a real problem, but neither them nor any other Albanian state institution have ever gone public about this issue.

Medical abortion was legalized in Albania in 2005, to acknowledge and take advantage of advances in technology and science, and to curb the number of deaths in women, and generally prevent health consequences from abortions performed outside of hospitals using old methods.

This decision was adopted after the completion of a pilot project that took place from October 2001 to May 2013 in two maternity hospitals in Tirana where 409 women interrupted their pregnancies using Mifepristone and Misoprostol pills, following a strict protocol, with the approval of the national board of population health.

This study, which was carried out with the participation of renowned Albanian doctors such as Orion Gliozheni, Rubena Moisu, Vjollca Tare and Ilir Tasha, proved successful in 97 percent of the women that took part in these trials.

As a result of this study the use of abortion pills was allowed to be used in Albania, but only with doctors’ prescriptions and under their supervision, as Mifepristone and Misoprostol were supposed to be distributed only by the medical staff of maternity hospitals.

Today, 12 years after their introduction to Albania, the distribution of abortion pills is carried out by pharmacists, often without requiring a doctor’s prescription or recommendation, and without any information on the health conditions of the woman.

Doctor Rubena Moisiu, former director of the university obstetrics and gynecology hospital Koço Gliozheni, tells PSE that “in Albania there are no formal regulations on the distribution of abortion pills,” even though “pharmaceutical abortion is permitted only under the supervision of doctors and following their recommendations, to avoid any negative health consequences.”

Avenir Balili, a doctor at the obstetrics and gynecology hospital Queen Geraldine, also stated that “after the pills were allowed in, there haven’t been any protocols, regulations or legislation in place to regulate their distribution.”

“We find ourselves in a situation where we know that the pills are being used but the legislation for their use in our country is missing,” he told PSE.

On the other hand, the unrestricted use of medical abortions appears to provide a distorted picture on the extent and the number of interrupted pregnancies in Albania.

The data from the Institute of Statistics show that the number of abortions has reduced considerably. As many as 31,292 abortions were reported in 1994, while in 2014 that number stood at only 5,572.

Doctor Avenir Balili believes that this figure is not an accurate description of the situation, because a considerable number of abortions are executed outside of health care institutions.

“I don’t believe that the number of abortions in Albania has fallen, I would probably say that it is more likely it has increased, but many of them now go unrecorded,” notes Balili.

Drugstores, where abortion pills are purchased as if aspirins

Pharmaceutical abortion is a widely accepted medical practice in many countries around the world, but nowhere else are Mifepristone and Misoprostol abortion pills administered without a doctor’s recommendation. These pills are prescribed to patients only after a thorough examination of the health of the woman.

Gynecologists tell PSE that this kind of abortion can be carried out until the seventh week of pregnancy, and that it may cause serious health complications in women if carried out after that time window. Serious complications may also arise if they are administered without doing an ultrasound examination and careful assessment of their health conditions.

However, what happens in real life is a completely different matter. After the four girls testified that they had bought abortion pills in drugstores without any prescriptions from doctors, PSE decide to test 30 pharmacies in Tirana, on whether they could be bought that easily.

In 10 drugstores PSE reporters could buy abortion pills without a doctor’s prescription or a picture ID. These pharmacies are located near the maternity hospital Queen Geraldine; on Dibra Street, near the university hospital Mother Teresa; at the former Bllok area; and at the Paris Commune neighborhood.

PSE journalists reported that these pills could be purchased at a price range between 4,000 to 10,000 Lek (USD30 – USD80). The four girls said in interviews that pharmacists posed very little or no resistance at all when they asked to purchase abortion pills.

Jonada H. from Fier told PSE that when she learned she was pregnant she went immediately at a drugstore and bought abortion pills easily, without any prescription.

“I went to the pharmacy and bought the pills. The lady at the drugstore instructed me on how to take those pills in order to have a safer abortion,” she says.

Arisa Y. from Durrës said that the lack of a prescription or a doctor’s recommendation was almost no problem at all when she bought those pills at the drugstore.

“I’d heard about aborting with pills and went at once at the pharmacy on the ground level of my apartment building,” she said. “The pharmacist asked to see a doctor’s prescription, but I didn’t have one, so I went to another pharmacy. I paid 5,000 Lek (near USD40) for those pills and ingested them, following instructions in the box.”

In the meantime, from a legal point of view, not even a doctor’s prescription should make these abortion pills available to drugstore customers, because Mifepristone and Misoprostol should not be available commercially, but are supposed to be distributed only by the medical staff of the departments of obstetrics and gynecology.

PSE confirmed this fact after contacting the National Agency of Pharmaceuticals and Medical Devices with a request for information, based on the freedom of information act.

“We inform you that Mifepristone and Misoprostol are not licensed for commercial use and retail in the Republic of Albania. Because of this, citizens who use them should be aware of the risks they may face in taking them, as these are pharmaceuticals that have not been cleared by the competent authority,” said the agency in a reply.

The Agency of Pharmaceuticals also denied any knowledge that these pills were being sold in drugstores in Albania.

“Our institution carries out periodical checks in all the pharmacies, inspecting storage conditions of pharmaceuticals and their retail. We have found no evidence of those medicaments being sold in pharmacies,” the agency said.

Saving face or saving lives

Medical abortion is cheaper than surgical abortion, but this is not the reason why women choose this method to interrupt their pregnancy.

The four girls interviewed by PSE say that pregnancies had come at an unfortunate moment in their lives, and telling others about their pregnancy would harm their reputation and standing in their families and society.

Buying pills at a drugstore secured them full confidentiality, without telling anyone or signing their names for a visit at the doctor.

Jonada H. says that a pregnancy at that moment in her life would not be welcomed at all by her family.

“I was a sophomore when I realized that I was pregnant by accident,” she recalls. “I could not believe it. It was awful just to imagine the reactions of my brother, parents, friends and acquaintances. They knew nothing of my relationship. After all, I had come to Tirana to study.”

Klodjana B. from Fier tells PSE that abortion was her only choice, as her conservative family would not tolerate an out-of-wedlock pregnancy.

“I was told that this kind of abortion could have side effects, but I had already made up my mind,” she says. “I come from a strict family, borderline conservative, so the thought of confronting them (about my pregnancy) did not even cross my mind.”

However, in order to save their reputation, they are putting their very lives at risk.

Doctor Avenir Balili admits that he has helped many women to recover from health problems due to pharmaceutical abortions.

“I’ve treated many women and girls who opted for medical abortion without first consulting a doctor,” he recalls. “Girls buy pills at pharmacies without any medical examination. Abortions are not recorded. We are cut out of this whole process and cannot provide any care to them, but when their conditions worsen the girls resign themselves to surgical medicine.”

A gynecologist at a private health clinic in Tirana, Mimoza Keta, says that she has helped many women to overcome health problems deriving from abortion pills taken without a doctor’s recommendation. Health complications ultimately forced these women to seek help in health clinics, thus pushing aside their qualms about social stigma.

“In my line of work I have with met many girls who have bought abortion pills in pharmacies,” Keta says. “They didn’t take them properly and as a result they had serious problems and were forced to visit medical clinics.”

Doctors also warn that health complications may be so severe that some of the women may never have children.

“Pharmaceutical abortion and the lack of medical supervision may lead to infertility,” says Avenir Balili. “The gravity of health problems may depend on the health conditions of the patients, the age of pregnancy, and the way the abortion pill is administered. When it gets really bad, the girls will have to undergo surgery to repair any damages.”

Jonada H. is one of those girls who had to undergo surgery after taking an abortion pill.

“After all the trouble I’d been through after I took the abortion pill without a doctor’s recommendation, I also had to go in surgery,” Jonada tells PSE. “Despite all the efforts, consequences endure. It will be difficult for me to get pregnant. Doctors believe it is the infection from the medical abortion.”