Misoprostol (or miso) is a drug which lessens postpartum bleeding, the leading cause of maternal death in the developing world. Traditional birth attendants in Mozambique who were part of a year-long trial of miso use in rural communities used words like “miraculous” to describe how beneficial misoprostal has been for women’s health. The birth attendants measured the effectiveness of miso with a cloth called the capulana. Before miso, birth attendants would need “three or four capulanas to soak up typical blood loss from the mother. After miso, they needed just one.” Increased access to miso in developing nations could help reduce the staggering discrepancy in maternal mortality rates between developing and developed nations. According to the World Health Organization (WHO), a woman in Mozambique has a 1 in 37 lifetime risk of maternal death. In the U.S., a woman’s lifetime risk of maternal death is 1 in 2,100.
While miso is not the ideal drug to use to prevent postpartum hemorrhage, it is the best option for many women who are in places with limited access to medical facilities, like rural Mozambique. Oxytocin is a better, more effective medicine at reducing excessive bleeding after childbirth but it must be injected. For those who have very limited access to medical equipment, administering miso (which comes in a tablet) is a more practical option. WHO now has misoprostol on its list of essential medicines for preventing postpartum hemorrhage. However, WHO pharmacologist Suzanne Hill said that in order to really change maternal mortality rates in countries like Mozambique it needs to be ensured that “women can get to facilities, can get care, can give birth in a controlled environment.” In the meantime, miso can help reduce, though not eliminate, the staggering discrepancy in the maternal death rates between developing and developed countries.
Despite the fact that increased access to miso would save women’s lives, women’s access to it is threatened because it can also be used to induce abortions. Some anti-choicers would rather deny women access to a life-saving drug as well as an avenue to safer abortion than make abortion “too easy” by increasing access to miso. While abortion is officially illegal in Mozambique, misoprostol is available without a prescription and women have started using it for abortion. Aida Libombo, an adviser to Mozambique’s minister of health and an OB-GYN told NPR that “misoprostol has made abortions much safer. She remembers the horrific botched abortions she dealt with as a young doctor in the 1980s, when unsafe abortion was one of the leading causes of maternal death.”
To learn more about the use of misoprostol to prevent and treat postpartum hemorrhage you can read WHO’s statement on it here [PDF].
