Rodolfo Gómez Ponce de León


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    Promoting misoprostol for multiple ob-gyn indications: A strategy for increasing access to safe abortion in Latin America

    Rodolfo Gómez Ponce de León, Virginia Chambers, Traci Baird, Leila Adesse and Pearl Friedberg (IPAS, United States)

    IPAS, United States

    Latin America has some of the world's most restrictive abortion laws and yet abortion is prevalent and the proportion of maternal deaths due to abortion is high. In the past two decades, misoprostol, which is widely accessible as an ulcer treatment drug, has been increasingly well known and used by women to self-induce abortion. In a few countries, health authorities have reacted to women’s own use of misoprostol by restricting access to the drug by making it available only by prescription or limiting its use to hospitals. Given the adverse political environment around abortion and the threat that misoprostol could become severely restricted, Ipas developed a regional strategy in 2004 to promote misoprostol for multiple ob-gyn indications, working closely with the Latin American Federation of Societies of Obstetrics and Gynecology (FLASOG), the Latin-American Consortium against Unsafe Abortion (CLACAI), and other partners.

    This multiple-indication approach serves to: open the door to talk with providers or policymakers about “safe” subjects, such as misoprostol for prevention of maternal deaths; increase provider knowledge, acceptance and correct use of misoprostol; reduce the stigma associated with the use of misoprostol; and reach a broad audience with information on misoprostol, even in countries where abortion is restricted. Ipas and our partners are also advocating for inclusion of misoprostol in health system guidelines and formularies for all obstetric uses.

    In 2005 FLASOG published and disseminated evidence based guidelines about the use of misoprostol for all ob-gyn indications, which serves as a key tool in educating healthcare providers on misoprostol. In 2007 this publication was updated, and 26,000 copies of the guideline, including the book, CD, and pocket-card, were disseminated to participants at national ob-gyn conferences in each country in the region. Before the formal introduction we distributed a questionnaire to a convenience sample of attendees evaluating their knowledge, use and training needs for misoprostol.

    We have had some concrete successes result from the multiple-indications strategy. For example, following the publication of the first edition of the FLASOG manual on misoprostol for ob-gyn uses in 2005, Ipas Brazil and the State Secretary of Health for Rio de Janeiro convened a working group of state hospital administrators and misoprostol experts to develop a consensus statement on ob-gyn uses of misoprostol. The consensus statement was disseminated throughout the state health system.

    In this presentation we will outline the major steps taken to promote misoprostol for a full range of ob-gyn indications, present data from surveys of ob-gyns in the region about misoprostol knowledge and use, and discuss the successes that have resulted from this strategy. We will also explore implications and recommendations for other regions.