Update Guidelines To Allow Abortion Pill, MOH Told

By Vinodh Pillai and Arjun Thanaraju | 04 March 2020

A senior MOH official recently said countries do not have to abide by WHO’s list of essential drugs that includes mifepristone and misoprostol.

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KUALA LUMPUR, March 4 — There is no reason why Malaysia should not update its clinical practice guidelines to allow the registration of abortion pills, two reproductive rights groups said.

This comes after a senior Ministry of Health (MOH) official said countries do not have to abide by a list of essential drugs recognised by the World Health Organization (WHO) that includes mifepristone and misoprostol, medications typically used to carry out abortions.

Reproductive rights advocate Dr Subatra Jayaraj said multiple clinical research has shown that medical abortions, when administered with the correct, recommended drug regimes for recommended gestations, are typically safe.

This is especially so for the first trimester termination of pregnancies, the secretary of the Reproductive Rights Advocacy Alliance Malaysia (RRAAM) told CodeBlue.

“It is time for Malaysia to update its clinical practice guidelines to include misoprostol use in the country, especially in light of the WHO transferring the drug onto the core list,” she said.

Last July, the WHO moved mifepristone and misoprostol from the complementary list to the core list of the 21st WHO Essential Medicines List, besides deleting a note that said the abortion pill required “close medical supervision”, as evidence showed this was not necessary for safe and effective use of the drug.

The WHO, however, retained a note for the mifepristone-misoprostol combination pack (mifepristone 200mg tablet and misoprostol 200 microgram tablet) that said: “where permitted under national law and where culturally acceptable”. Both drugs are not allowed to be sold in Malaysia, and abortion is only permitted in Malaysia if it endangers the mother.

CodeBlue reported Dr Ramli Zainal, senior director of MOH’s pharmaceutical services programme, as saying last January that the ministry bases its decisions on the standard clinical practice guidelines for the country, which does not list misoprostol as a recommended drug for abortion.

He added that a panel of expert physicians has long determined that there is no need for misoprostol use in the country, and expressed doubt that this would be changed any time soon.

Dr Subatra said it is a “fallacy” that abortion pills are not needed, as an estimate of 100,000 abortions are sought out every year in Malaysia. This means that about 10 abortions are being carried out by the hour.

“We are only blocking access to gold standard health care,” she said, by “creating an atmosphere” where women have to seek out unsafe services by purchasing black market pills online, away from registered medical practitioners.

Dr Subatra said while evidence showed that the abortion pill use does not require close medical supervision, as it was not necessary for safe and effective use of the drug, there is a way MOH can go about this and be worry-free.

“They should facilitate registered medical practitioners to have access to the drug, so that proper high quality medical standards can be practiced.”

Dr Subatra Jayaraj, secretary of the Reproductive Rights Advocacy Alliance Malaysia (RRAAM)

“Outrightly preventing registered medical practitioners to provide the medication in Malaysia has only led to the mushrooming of black market non-skilled sellers profiteering and exploiting a potentially straightforward, life changing procedure,” she said.

Dr Subatra also called for the availability of evidence-based medicine for women in Malaysia, adding that there is no reason why women in Malaysia should be denied access to a safe, essential drug in the year 2020.

Meanwhile, the Federation of Reproductive Health Associations, Malaysia (FRHAM) said the fact that there is a rise in illegal sales of abortion pills showed that desperate women will find ways to terminate unwanted pregnancies, following efforts by MOH to crack down on the sale of abortion pills.

“This has led to many abortion-related complications with unsupervised dosage and even adulterated pills,” said FRHAM chairperson Dr Philip Kho. “The associated risks of maternal mortality and morbidity are significant.”

Dr Philip told CodeBlue that every woman should be able to make decisions on her circumstances based on informed choice, and that the harm reduction approach is a viable solution for women to reduce instances of unsafe abortion.

He said MOH should consider registering both medications to provide medical practitioners access to the drugs. Mifepristone was never registered in Malaysia, while misoprostol was deregistered as it was felt that there is “no need” for misoprostol use for abortion in Malaysia.

Both drugs are needed, he noted, as medical abortion is successful in about 95 out of 100 cases for pregnancies less than two months using the combination of mifepristone and misoprostol. But if only misoprostol is used, the rate of successful medical abortion is about 85 out of 100 cases.

“Registering the medications in Malaysia for the purpose of safe abortion when legal circumstances permit will ensure access to quality-controlled supervised dosage of the pills and allay fears of misuse,” he added. “It will also help to curb the illegal sale of these pills online.”

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