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Helping Women and Communities through Acceptance and Use of Misoprostol

From 4-6 May, the Asia Regional Meeting on Interventions for Impact in Essential Obstetric and Newborn Care was held in Dhaka, Bangladesh. Organized by the Government of Bangladesh, MCHIP, and the Bill & Melinda Gates Foundation-supported Oxytocin Initiative, in collaboration with Women Deliver, VSI, FIGO, and ICM, this three-day meeting focused on postpartum hemorrhage (PPH), pre-eclampsia/eclampsia (PE/E) and other aspects of maternal and newborn health.

Dr. Nuriye Hodoglugil, VSI Associate Medical Director, was asked to blog during the Asia Regional Meeting. Dr. Nuriye's entry was the first in a series of blogs from conference attendees.

Though I have been in this field for over 20 years, I first became interested in women’s health and family planning when I prepared a presentation about contraceptive methods during medical school in the early 1990s. When I found out that simple information and contraceptive methods were not available to many women, it triggered a very strong response in me. It felt very unfair. I thought, if women are carrying the largest burden of reproduction due to their biology, they should have the means to do it well for the benefit of their families and society.

One of the ways that I believe we can help women and their communities is through the acceptance and use of misoprostol. Misoprostol is a type of uterotonic drug that helps to induce labor and prevent postpartum hemorrhage (PPH), the leading cause of maternal death. In Asia, the evidence is clear that women have been very responsive to the provision of misoprostol for PPH prevention at the community level. Women have understood how to use misoprostol correctly and it was the success of women, community health workers, traditional birth attendants and everybody else who was present at the time of birth that gave us these good results.

I think one of the greatest barriers to the use of misoprostol is the assumption about what women might do, not trusting them. For instance, we had assumptions about how they would behave when they were given misoprostol in advance for PPH—would they run back to their homes and never come to the facility again? Or will they misuse it for other indications?

I believe we should focus on what works to prevent maternal deaths and the best ways to ensure that PPH management programs are safe and effective for women and their communities. We must ask women what they need, and trust that they will choose the best thing for themselves and for their babies. And in order to ensure the quality and potential impact of misoprostol use, we need to continue monitoring and evaluating our programs, and give clear guidance on how the drug works and should be used. We must also scale up community-level use of misoprostol until it is a routine part of care for all pregnant women, particularly at home deliveries.

What I have realized in the course of my work is the importance of community and culture, which sometimes contrast sharply in opinion with the medical establishment. I think misoprostol is a very good example of how these two spheres—community and medicine—can be combined to reach the same goal: saving women from dying during childbirth. If we all agree that improving a woman's health is one of the best ways to empower her, we must make the mutual commitment to do whatever we can to improve the conditions for women.

Helping Women and Communities through Acceptance and Use of Misoprostol

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