Self Medication for MTP

She came for antenatal registration with a retired sister-in-charge who had worked with us in the past. I started taking her history. “I had a normal delivery 4 years ago” she said. “Then I got an MTP by taking abortion pills.” “Who prescribed the pills?” I asked. “My sister-in-law” she said. “Is she a gynecologist?” I asked. “No. She is not a doctor. She had used such pills herself and told me to take the same because I did not want that baby.” “Do you know the pills are to be prescribed by a qualified person, and can be dangerous to health if taken without a check up and supervision.” “I am a staff nurse myself” she said. “Where do you work” I asked. “In a primary health center” she said. “Do you give abortion pills to women coming to the center?” I asked. “No!” she said. “Why not? You trust them to work on yourself. Then why not on those patients?” She kept quiet. “Do you know that if they are used when the pregnancy is more than 9 weeks, the abortion can be incomplete and there can be severe bleeding?” She said neither yes nor no. “DO you know that if the pregnancy is ectopic, e.g. in the fallopian tube, it can rupture when you take these pills and you can die if not operated on in time?” “But I had done a urine pregnancy test on myself. It was positive” she said. “Urine pregnancy test is often positive in an ectopic pregnancy” I said. She did not seem to have known about it. “An operation for a ruptured ectopic pregnancy is also not all that safe. One often required blood transfusions. That can be associated with a number of complications, including transmission of infections like HIV infection. The patient then dies sooner or later.” She seemed happy that she had not required an operation of that nature. “Actually I did not intend to take those pills” she said. “I took them by mistake.” “Huh? You mean they were in a box of chocolates, and you took them thinking they were chocolates?” I could be sarcastic. I was her doctor and had to educate her. She smiled rather than giving a smart answer. After all I was her doctor and she needed me. “How is this sister-in-law related to you?” I asked. “Is she your husband’s sister?” “Yes” she said. “That perhaps explains it” I said. “Sisters-in-law often do not get along well. Perhaps they would find another wife for your husband when you died.” “No, no” she said, but her heart was not in it. Perhaps she believed that was the sister-in-law’s intention. “You seem bent on harming yourself” I said. “You failed once. Why don’t you find a good sized rock and slam it on your foot? We have building repair work in progress. There are plenty of rocks outside.” “I won’t take abortion pills by myself again” she promised. I hoped she would discourage others from taking such pills to, even that sister-in-law.