Shafia Rashid is Senior Technical Advisor for the FCI Program of Management Sciences for Health.
Available since the 1980s, the medicine misoprostol was initially marketed to prevent stomach ulcers. Health professionals eventually discovered that misoprostol also stimulates contractions of the uterus, making it useful for a number of maternal and reproductive health conditions, including postpartum hemorrhage (PPH), induction of labor, treatment of miscarriage, and induced abortion (alone or in combination with mifepristone). Misoprostol is stable at room temperature, available in pill form, and inexpensive. Because of these advantages and misoprostol’s wide availability in many countries, health providers began using misoprostol off-label—in a way not specified on its registration—with differing regimens and routes of administration, and in the absence of evidence-based clinical guidelines.
Partly because of its role in addressing the global burden of PPH, the leading cause of maternal death in low-resource settings, misoprostol has been studied extensively for its safety, efficacy, and acceptability to women. Now, a global consensus, backed by scientific and programmatic evidence, affirms that misoprostol can effectively prevent and treat postpartum bleeding. In particular, misoprostol has the potential to reach women who give birth, by choice or by necessity, at home or in health facilities that lack electricity, refrigeration, and/or skilled health providers.
With the science and research supporting misoprostol for PPH firmly in place, we now need to focus on strengthening the broader health system to ensure that quality misoprostol products are available and accessible to every woman, wherever she gives birth. Indeed, with the launch of the United Nations Commissions for Life-Saving Commodities for Women and Children (UNCOLSC) in 2012, many partners have since worked together to address a range of systems issues–policy and governance, supply chain management, health information and financing–to improve the availability and use of essential, life-saving medicines for women and children. Over the past few years, other important developments have supported the use of misoprostol as part of a functioning health system:
- Policies and guidelines: The WHO Model List of Essential Medicines (EML) now includes misoprostol for both PPH prevention and treatment, validating its important role for women’s health and survival. Many global and national clinical guidelines have identified misoprostol as a key intervention for addressing PPH.
- Quality assurance and registration: Misoprostol is registered for PPH indications in more than 30 countries. Quality-assured misoprostol products (Misoprost, GyMiso, and Hemaprostol) are available for procurement in low- and middle-income markets.
In spite of this progress, sustained, evidence-based advocacy is needed to ensure that governments make misoprostol available in the public health sector, and health providers use it appropriately in both facility and community settings. Effective advocacy can, for example, help ensure that misoprostol for PPH is included in a country’s essential medicine list. Advocates can strengthen national decision-makers’ understanding and support for increased access to misoprostol as well as mitigate concerns that promotion of its use in home births may deter women from seeking care at health facilities. Advocates can also share evidence to discourage perceptions that misoprostol will be re-purposed for use in medical abortion if it’s made widely available for PPH.The FCI program of Management Sciences for Health (MSH) is working with partners to ensure that concerted action at the policy level will lead to sustainable improvements in misoprostol’s availability for PPH.
Access to essential, life-saving medicines is a matter of health equity. Women–especially those from remote, impoverished, and marginalized communities—must have access to the high-quality care and technologies that enable them to realize their fundamental rights to life, health, equality and non-discrimination. No matter where a woman gives birth, health care must be available, accessible, and of high quality. This April 11th, International Day for Maternal Health and Rights, is a stark reminder that we must continue to ensure that all women have access to essential, life-saving medicines as a basic human right.