Translating promise into reality: Misoprostol for post-partum hemorrhage
Ann Starrs is president of Family Care International.
Every five minutes, somewhere in the developing world, a woman who has just given birth bleeds to death. Almost all of these cases of postpartum hemorrhage (PPH) can be prevented or effectively treated if every woman has access to essential health services and medicines, and particularly to uterotonic drugs.
Misoprostol is one such drug. Research has shown it to be safe and effective for stopping postpartum bleeding, the leading cause of death in childbirth. Misoprostol offers several unique advantages, particularly for use in low-level health facilities and in community and home birth settings: it doesn’t require refrigeration, is simple to administer, is inexpensive, and is widely available. But many women still do not have access to this critical medicine – even though misoprostol is on the World Health Organization’s Model List of Essential Medicines for the prevention of PPH, is on the national essential drug lists in many countries, and is included in many global and national clinical practice guidelines.
In “Misoprostol for postpartum hemorrhage: Moving from evidence to practice,” a commentary we co-authored for the January 2012 issue of the International Journal of Gynecology & Obstetrics (IJGO), Beverly Winikoff (president of Gynuity Health Projects) and I note the “growing consensus that misoprostol is a safe and effective option for preventing and treating PPH, particularly in settings where oxytocin — the gold standard drug — is not available or where its administration is not feasible.” This article grew out of a multi-year collaboration between Gynuity and FCI to evaluate misoprostol and to promote wider understanding, use, and acceptance of misoprostol for preventing and treating PPH. In it, we outline the unique challenges to expanding women’s access to and use of misoprostol, including:
- Misoprostol’s use for a range of indications, which has resulted in controversy about its possible “misuse.” Misoprostol can be used to induce abortion early in pregnancy, and can cause complications if used incorrectly before or after delivery, which has made some governments, donors, and health care professional reluctant to promote it even for appropriate uses.
- Evidence-based guidelines and clinical protocols that, in many countries, do not reflect the latest research, and a lack of provider training in its proper use.
- Misconceptions and misperceptions held by policy makers and health practitioners, including a fear — unsupported by the evidence — that promoting misoprostol’s use in home births could deter women from giving birth at health facilities.
There is no panacea for reducing maternal mortality: as we point out in the article’s conclusion, “no drug can replace the need for strengthened basic and emergency obstetric care services; for more and better-trained health workers; for clean, well-equipped facilities; and for culturally-sensitive, high-quality maternal health care.” But misoprostol is an essential tool, one that can help us to deliver on the world’s promise to improve maternal health. To make progress in ensuring that every woman has access to a uterotonic to prevent or treat PPH, the medical and health policy communities must work together to translate research findings on misoprostol into changes in policy, knowledge, and clinical practice.
Read the full article here.
Learn more about FCI’s work on misoprostol and PPH here.