Written by: Shafia Rashid, Senior Program Officer, FCI Global Advocacy program.
The following was originally posted on FCI’s blog. It is reposted here with permission.
Around the corner from the New York Stock Exchange, where financial decisions of global importance are made every day, more than 50 obstetricians, midwives, women’s rights advocates, public health programmers, researchers, and policy makers from around the world gathered last week for discussions on a different, but equally momentous, subject. FCI, working in collaboration with Gynuity Health Projects, brought together this diverse group for a two-day meeting to help shape policy and advocacy on the use of the drug misoprostol for the prevention and treatment of postpartum hemorrhage (PPH). In the developing world, uncontrolled post-partum bleeding is the leading cause of death in childbirth, killing a woman every five minutes.
In studies conducted by Gynuity and others, misoprostol has been shown to be a safe and effective medicine both for the prevention and for the treatment of PPH. While another drug, oxytocin, is generally recognized as the “gold standard” among uterotonic drugs for preventing or treating PPH, misoprostol has significant advantages for use in settings where maternal mortality is high and most births take place outside of hospitals: misoprostol is delivered in tablet form, and — unlike oxytocin — requires neither refrigeration nor intravenous administration. Earlier this year, 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. Misoprostol, originally developed for treatment of stomach ulcers, is also used for a range of reproductive health indications, including induction and augmentation of labor and medical abortion.
The New York meeting aimed to translate the scientific evidence on misoprostol’s safety and efficacy into effective strategies for expanding women’s access to misoprostol at the country level. After reviewing the scientific research, the global clinical and policy guidelines that shape the use and availability of misoprostol, and the strategies being used by misoprostol advocates and programmers, participants discussed opportunities, barriers, and challenges related to promoting greater access to misoprostol for PPH. Human rights experts framed how access to misoprostol is a human right enshrined in several international frameworks, including the Universal Declaration of Human Rights. Presentations and discussions highlighted the need not only to drive policy change at the country level (e.g., getting misoprostol registered for this indication, including it on national essential drug lists, and incorporating it within national clinical norms and guidelines), but also to ensure that these policies are adequately implemented and funded so that they translate into real progress for women.
Presenters from Nepal, Kenya, and Ecuador shared lessons from successful efforts to achieve policy approval and expand distribution of misoprostol, and participants from countries including India, Tanzania, Uganda, Burkina Faso, and Laos also contributed their experiences. These discussions included promising results from several countries where distribution of misoprostol tablets to women in their communities has proven effective in addressing the risk of hemorrhage among women who give birth at home — where more than half of births in the developing world still take place — with extremely low levels of diversion of the drug for other uses, incorrect dosage or timing of administration, or other signs of poor compliance. Attendees also learned about advocacy campaigns in related sectors, including emergency contraception, medical abortion, and the HPV vaccine for cervical cancer, and considered how those lessons may be applied to improving access to misoprostol for PPH.
Looking ahead, FCI will work with our partners to develop and implement an advocacy and communications strategy that will drive real progress in helping countries, health care providers, and women themselves address the leading cause of maternal death. Please stay tuned to The FCI Blog for more information as this exciting and important project moves forward.
To read FCI’s mapping report on advocacy for access to misoprostol, click here: Mapping_Miso_For_PPH.
To read about FCI’s work on misoprostol for PPH, click here.
Making Outpatient Abortion Services a Reality
Thursday, September 2nd, 2010 by KateMitchWritten by Janna Oberdorf, Women Deliver
Every year, an estimated 20 million unsafe abortions take place. And of all maternal deaths, unsafe abortion accounts for 13%. Imagine if we could change that. Imagine if we could make a serious dent in the deaths and morbidities that are caused from botched abortions, from unhygienic surgeries, and from unskilled providers.
Now, imagine if we could change that with a few simple, low-cost pills. That’s what the drugs mifepristone and misoprostol are doing for women around the world.
At today’s panel session on “Reducing the toll of unsafe abortion using simple medical technology” at the Global Maternal Health Conference in Delhi, panelists laid out the landscape of how introducing and expanding access to medical abortions could save lives and prevent injury:
• Beverly Winikoff, of Gynuity Health Projects, talked about misoprostol as first-line treatment of incomplete abortion, and about introducing and expanding existing services and implications for training. As she said, misoprostol is low cost, and it can increase women’s choice and reduce the burden on doctors and health facilities.
• Patricio Sanhueza Smith, from the Secretariat of Health in Mexico City, talked about lessons learned from Mexico City on the potential of misoprostol alone for transitioning services. He said, “Medical abortion with misoprostol alone is not the Gold Standard, but it is a duty to widely disseminate its use, while mifepristone becomes available.”
• Selma Hajiri, of the Center for Research and Consultancy in Reproductive Health, talked about a randomized controlled trial of medical abortion with misoprostol only versus mifepristone plus misoprostol. She said that although the combination is the gold standard, misoprostol alone should be promoted where mifepristone is not accessible.
• Kelsey Lynd, of Stanford University, spoke about making outpatient services a reality. She discussed research on administering mifepristone and misoprostol at home, and a pregnancy test that could simplify medical abortion provision.
• Hillary Bracken, of Gynuity Health Projects, spoke about expanding access late in the first trimester, and the promise of outpatient mifepristone and misoprostol after 63 days.
Though I’m constantly amazed by the possibility and potential of mifepristone and misoprostol for safe abortion, I was even more amazed to hear about Kelsey Lynd’s work on making outpatient services a reality.
Having an abortion is a difficult and traumatic decision, with serious health repercussions. But that decision becomes so much harder when you have to pay for a sonogram to determine gestation period; to attend a clinic to take the mifepristone; to return to the clinic two week later for a follow-up visit and second dose; and to have a second sonogram to ensure the pregnancy was terminated. It’s a time-consuming and costly decision… but every one of those steps also takes an emotional toll.
Lynd presented research that showed that it is safe for women to self-administer mifepristone and misoprostol at home. Though this is great news for time and money saving reasons, it also gives women some control and choice over when to start their abortion.
Lynd also presented findings on a home pregnancy test that determine their pregnancy status after abortion. This semi-quantitative pregnancy test is administered at the health facility while the woman is pregnant to achieve a baseline of her hCG blood level. Then, 1 to 2 weeks after the woman has been administered mifepristone and misoprostol, she can use the test to check if her hCG blood level has decreased, thus confirming termination of pregnancy. In her findings, 98% of women felt they could use the test on their own in the future, and the tests identified ALL ongoing pregnancies.
The implications for this research are mind-boggling. I think it is obvious that cutting down clinic visits and sonograms would save time (for the woman and the provider) and save money. But it is the emotional implications that jump out at me. The ability for women to feel they have some control over their bodies and their abortions is something that is severely needed.
One last note is that although these findings are encouraging in making outpatient services a reality, they must be partnered with education, information, and counseling. Home abortions are a scary thing. Bleeding for days on end is a scary thing. And women need to understand complications that need treatment, and have some emotional support. We need to guide these women with the proper education, counseling, call centers, job-aids, and more, if and when we finally make outpatient services a reality.
Janna Oberdorf is the Communications Manager at Women Deliver.
Follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.
For more posts about the Global Maternal Health Conference, click here.
For the live stream schedule, click here.
Check back soon for the archived videos of today’s presentations.
[Translate]
Tags: Beverly Winikoff, Center for Research and Consultancy in Reproductive Health, Global Maternal Health Conference 2010, Gynuity Health Projects, Hillary Bracken, Janna Overdorf, Kelsey Lynd, maternal death, maternal morbidity, maternal mortality, medical abortion, mifepristone, misoprostol, outpatien abortion, Patricio Sanhueza Smith, Secretariat of Health in Mexico City, Selma Hajiri, Stanford University, unsafe abortion, Women Deliver
Posted in Commentary, Meetings | No Comments »