Misoprostol for treatment of postpartum hemorrhage added to WHO Essential Medicines List

Shafia Rashid is senior program officer for Global Advocacy at Family Care International.

For more than five years, FCI has been working with Gynuity Health Projects and other partners to build the evidence base for expanded availability and use of misoprostol for the prevention and treatment of postpartum hemorrhage (PPH). PPH is the leading cause of maternal death, and misoprostol is a safe, effective medicine that is especially practical in low-resource settings, because it is available as a tablet and does not require refrigeration or injection.

This week marked an important milestone in global efforts to make misoprostol available to the women who need it, as the World Health Organization (WHO) approved its inclusion on the Model List of Essential Medicines (EML) for the treatment of PPH. Misoprostol was included on the EML for prevention of PPH in 2011, and the recent decision signifies WHO’s full endorsement of misoprostol as an essential maternal health medicine in settings where oxytocin — which requires cold storage and intravenous injection — is not available or cannot be used safely. The WHO Expert Committee for the Selection and Use of Essential Medicines, a panel that meets every two years to update the EML, recommended that misoprostol be listed for the additional indication of treating PPH[1] and retained on the list for prevention of PPH.

Earlier this year, FCI joined with partners to support Gynuity’s application to the Expert Committee, to share evidence that misoprostol is safe, effective, and cost-effective for treating PPH. Indeed, many global health organizations and health professional associations, including the United Nations Commission on Life-Saving Commodities, the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives, support the use of misoprostol for both prevention and treatment of PPH in settings where use of oxytocin is not practical.

Oxytocin, considered the gold standard for treating PPH, is already listed on the WHO EML. Because cold storage and skilled providers are often unavailable in low-resource settings, use of oxytocin is often not feasible outside of high-level, well-equipped health facilities. Misoprostol is a widely-available, practical, and inexpensive medicine that can expand the range of medical interventions that health providers in facilities and in community settings can use to treat women who are experiencing PPH.

The EML provides guidance to national leaders and Ministries of Health on the medicines to be prioritized in national medicines lists and procurement strategies. The essential medicines list also guides the medicine supply system of international organizations, including UNICEF, UNHCR and UNFPA, nongovernmental organizations, and international non-profit supply agencies. It marks an important step forward in making essential, life-saving medicines more widely available, and provides a critical opportunity for disseminating evidence-based information to ministries of health, regulatory authorities, health system managers, and health workers.

FCI and its partners will continue to work, building on this important advocacy achievement with WHO, to ensure that every woman has access to the essential medicines she needs for a pregnancy and childbirth that is safe and healthy for her and her baby.

For more information:

Report of the 20th WHO Expert Committee on the Selection and Use of Essential Medicines

2015 WHO Model list of Essential Medicines

[1] The other indications for which misoprostol is listed in the WHO EML: prevention of PPH, early medical abortion (with mifepristone), management of incomplete abortion/miscarriage, and induction of labor.

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