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Mapping Misoprostol for Postpartum Hemorrhage

2011 June 14
by Shafia Rashid

Shafia Rashid is a senior program officer in FCI’s Global Advocacy program.

Postpartum hemorrhage (PPH) is the largest cause of maternal mortality, accounting for nearly one-quarter of maternal deaths. Preventing and treating PPH is especially difficult in places where most births occur in homes or in local clinics and where access to emergency obstetric care is limited. Evidence shows that misoprostol —a medicine that can be delivered in pill form and stored without refrigeration — can play an important role in preventing and treating PPH.

Just last month, misoprostol was added to the World Health Organization’s Model List of Essential Medicines for the prevention of PPH, providing another opportunity to expand women’s access to this safe and inexpensive medicine. It is critically important that clear, evidence-based information about misoprostol and its appropriate uses be disseminated to ministries of health, regulatory authorities, health system managers, health workers, and other key audiences.

FCI, working with Gynuity Health Projects, commissioned a mapping to identify activities and approaches being taken by organizations working on misoprostol for PPH. Over thirty organizations were asked to describe their activities, share their motivations for including misoprostol in their work, discuss barriers they have encountered, and suggest strategies for addressing these barriers.  One of our most surprising findings: the integration of misoprostol for PPH into reproductive health programming is rapidly gaining traction.  Several organizations noted that misoprostol offers a real opportunity to make a difference in maternal mortality—one that is not dependent on waiting for health systems to be strengthened—and they want to act on this opportunity as quickly as possible to save women’s lives.

The mapping highlights the need for several key actions:

  • Build consensus around evidence-based guidelines: There remain concerns about insufficient data supporting misoprostol’s distribution and use at the community/home level, and whether promotion of misoprostol at this level could deter women from seeking care at facilities with trained providers. While these concerns may be valid from an intellectual perspective, they ignore the realities faced by women giving birth in low-resource settings: that basic childbirth care in facilities (including access to oxytocin, which requires refrigeration and injection) is still not available to a large number of women.
  • Address misoprostol’s association with abortion: Misoprostol is a drug that has multiple promises for saving lives, including its use for abortion. While this has political implications in many areas, health providers require accurate, evidence-based information about how misoprostol is best used for each indication— labor induction, PPH prevention, PPH treatment, postabortion care, and abortion.

The mapping revealed key areas of convergence, as well as disagreement, within the global policy and scientific community. Building on the findings, and in response to the challenges outlined in this report, FCI will work with partners to identify policy approaches on which consensus can be achieved; to harmonize messages regarding the use of misoprostol for PPH; and to influence policy change in support of misoprostol at the national and global levels.

While more research is needed to build the evidence on community-level distribution, misoprostol clearly shows promise for meeting several reproductive health needs of women, including the prevention and treatment of postpartum hemorrhage. It is time to capitalize on its ready availability, low cost, convenience, and safety, and get it to women in ways that will best protect their health and preserve their lives. 

To read the full mapping report, click here: Mapping_Miso_For_PPH

To read about FCI’s work on misoprostol for PPH, click here.

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