Turin woman dies after taking 'abortion pill'

Expert denies first Italian death linked to mifepristone

(ANSA) - Turin, April 11 - A Turin woman has become the first Italian fatality possibly linked to the emergency contraceptive mifepristone, the so-called 'abortion pill'. The woman, 37, died at Turin's Martini Hospital after an abortion brought on by the pill, known in Italy by its former name, RU486. An autopsy has been ordered.

The hospital linked the death to a reaction to the pill but Italy's top expert on abortions, Turin gynecologist Silvio Viale, said the death was probably caused by sedatives which have been known to trigger cardiac arrest. Viale claimed there was only one fatality due to RU486, in France in 1991, but in that case too it was caused by complications "rather than the drug itself". "I feel obliged to warn against any instrumental exploitation of this death," said Viale, head of Italy's largest abortion ward at Turin's Sant'Anna hospital. Since its introduction in several countries more than 25 years ago there have been a handful of deaths allegedly linked to the pill, including eight cases of "lethal intolerance" in the United States.

Mifepristone has long had a symbolic significance transcending its medical use. When it was approved by the US Food and Drug Administration in 2000, advocacy groups insisted that it would change the nature of abortions, taking them out of clinics, where women might face harassment by abortion opponents, and into the privacy of a doctor's office. Abortion opponents said it was dangerous and would lead to suffering and deaths.

Neither turned out to be right as almost 90% of abortions continued to be carried out in clinics while the drug was judged "safe and effective" by US medical authorities. In Italy, where many doctors and pharmacists are Catholic conscientious objectors to abortion, women have often found it hard to get mifepristone even on a prescription. The pill was first administered in Italy on April 7, 2010, at a hospital in the southern city of Bari, as a group of pro-life activists protested outside. From 2006 to 2009 Italian hospitals ran some 200 tests using the RU486 pill, importing it from France. The April 2010 case was the first time that the so-called abortion pill had been purchased directly from its Italian distributors.

According to Italian law the RU486 pill - not to be confused with the morning-after pill that has been in use in Italy since 2000 - can be taken by women up until the 49th day of pregnancy under medical supervision in hospital, offering an alternative to surgical abortion. During the three-year experimental phase the pill was administered to day-hospital patients. RU486 was first introduced in France in 1988 and is now used in most European countries including Greece, Spain, Belgium and the United Kingdom. Its introduction in Italy met with stiff opposition from the Catholic Church as well as pro-life politicians and activists. Responding to ethical and health concerns, the health ministry set up a standing committee to monitor the use of the pill in Italian hospitals.

Ministry officials expressed concern that regional governments could issue different protocols for the drug, creating confusion and raising the likelihood of improper use. Italy's National Pharmaceutical Agency AIFA first approved the RU486 pill in July 2009 but its use was put on hold during a Senate inquiry into concerns over its safety and compatibility with Italian abortion laws.

The inquiry gave way to a bitter debate inside and outside parliament, with Catholic Church officials threatening excommunication for anyone who took or prescribed the new drug. The rate of abortions in Italy has been falling over recent years and is one of the lowest in the West. According to the latest figures, for 2012, the number of abortions performed in Italy has been decreasing while the number of doctors who are conscientious objectors to the procedure has been on the rise. In 2012, 105,968 abortions were performed, a decrease of 4.9% compared to the previous year, the report said.

The report also found that the number of abortions dropped dramatically " by almost 55% - compared with the figures for 30 years ago, while the percentage of doctors refusing to do them rose by 17.3% between 1982 and 2012. The report said that the number of abortions peaked at 234,801 in 1982. An estimated 15,000 illegal abortions are also carried out each year. Pro-choice activists have complained that a growing number of pro-life medical practitioners are making it tougher for women to obtain abortions. Under Italian law, doctors can refuse to perform an abortion if it runs counter to their principles.

Recent health ministry figures suggest that 70% of all Italian gynaecologists are now 'conscientious objectors' compared to 58.7% in 2003 while 50.4% of anaesthetists are opposed to abortion, compared to 45.7% in 2003.