Decentralizing postabortion care in Senegal with misoprostol for incomplete abortion

Gaye, Alioune; Diop, Ayisha; Shochet, Tara; Winikoff, Beverly

doi:10.1016/j.ijgo.2014.03.028

Cited by 24 publications

(24 citation statements)

References 8 publications

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“…The overall complete abortion rate in our study was similar to results in previous studies (range 94-99%). 8,10,29 Decentralisation of misoprostol use in post-abortion care has been successful in a similar setting, where ultrasound is not routinely used and physicians are scarce, 24 which is consistent with our fi ndings. In Uganda, most physicians work in the central urban region serving less than one third of the population.…”

Section: Discussionsupporting

confidence: 88%

Comparison of treatment of incomplete abortion with misoprostol by physicians and midwives at district level in Uganda: a randomised controlled equivalence trial

et al. 2015

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PostprintThis is the accepted version of a paper published in The Lancet. This paper has been peer-reviewed but does not include the final publisher proof-corrections or journal pagination.Citation for the original published paper (version of record):Klingberg-Allvin, M., Cleeve, A., Atuhairwe, S., Tumwesigye, N M., Faxelid, E. et al. (2015) Comparison of treatment of incomplete abortion with misoprostol by physicians and midwives at district level in Uganda: a randomised controlled equivalence trial.

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Section: Discussionsupporting

confidence: 88%

Comparison of treatment of incomplete abortion with misoprostol by physicians and midwives at district level in Uganda: a randomised controlled equivalence trial

et al. 2015

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“…Unlike surgical PAC (manual or electric vacuum aspiration or dilation and curettage), misoprostol requires no surgical skills or equipment to administer making it feasible to scale up in resource scarce settings [34]. However, there is limited availability of misoprostol in facilities offering maternity services in Senegal [14] which may be due to lack of awareness of its reproductive health uses and limited supply of the drug.…”

Section: Discussionmentioning

confidence: 99%

“…Several brands of misoprostol exist on the market today, one of which, Misoclear®, is registered for gynaecological indications such as PPH and PAC. Recent research on misoprostol provision at the community level for PPH and PAC in Senegal has shown high levels of efficacy and acceptability [13, 14] and found it to be more cost effective for PPH prevention than oxytocin [15]. However, misoprostol remains underused [13, 14], and its availability in public and private health facilities is limited [16].…”

Section: Introductionmentioning

confidence: 99%

Knowledge and provision of misoprostol among pharmacy workers in Senegal: a cross sectional study

Reiss

Footman

Burke³

et al. 2017

BMC Pregnancy Childbirth

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BackgroundMaking misoprostol widely available for management of postpartum haemorrhage (PPH) and post abortion care (PAC) is essential for reducing maternal mortality. Private pharmacies (thereafter called “pharmacies”) are integral in supplying medications to the general public in Senegal. In the case of misoprostol, pharmacies are also the main supplier to public providers and therefore have a key role in increasing its availability. This study seeks to understand knowledge and provision of misoprostol among pharmacy workers in Dakar, Senegal.MethodsA cross-sectional survey was conducted in Dakar, Senegal. 110 pharmacy workers were interviewed face-to-face to collect information on their knowledge and practice relating to the provision of misoprostol.ResultsThere are low levels of knowledge about misoprostol uses, registration status, treatment regimens and side effects among pharmacy workers, and corresponding low levels of training on its uses for reproductive health. Provision of misoprostol was low; of the 72% (n = 79) of pharmacy workers who had heard of the product, 35% (n = 27) reported selling it, though rarely for reproductive health indications. Almost half (49%, n = 25) of the respondents who did not sell misoprostol expressed willingness to do so. The main reasons pharmacy workers gave for not selling the product included stock outs (due to product unavailability from the supplier), perceived lack of demand and unwillingness to stock an abortifacient.ConclusionsKnowledge and availability of misoprostol in pharmacies in Senegal is low, posing potential challenges for delivery of post-abortion care and obstetric care. Training is required to address low levels of knowledge of misoprostol registration and uses among pharmacy workers. Barriers that prevent pharmacy workers from stocking misoprostol, including weaknesses in the supply chain and stigmatisation of the product must be addressed. Low reported sales for reproductive health indications also suggest limited prescribing of the product by health providers. Further research is needed to explore the reasons for this barrier to misoprostol availability.

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“…Such revisions might include integrating MVA into the national medical supply system and into national training curricula for nurses and midwives. A recent study demonstrated the effectiveness of Misoprostol in treating incomplete abortion at community health posts in Senegal (Gaye et al 2014). This drug should also be available through the national medical supply system as a form of PAC treatment.…”

Section: Discussionmentioning

confidence: 99%

“Right tool,” wrong “job”: Manual vacuum aspiration, post-abortion care and transnational population politics in Senegal

Suh¹

2015

Social Science & Medicine

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The “rightness” of a technology for completing a particular task is negotiated by medical professionals, patients, state institutions, manufacturing companies, and non-governmental organizations. This paper shows how certain technologies may challenge the meaning of the “job” they are designed to accomplish. Manual vacuum aspiration (MVA) is a syringe device for uterine evacuation that can be used to treat complications of incomplete abortion, known as post-abortion care (PAC), or to terminate pregnancy. I explore how negotiations over the rightness of MVA as well as PAC unfold at the intersection of national and global reproductive politics during the daily treatment of abortion complications at three hospitals in Senegal, where PAC is permitted but induced abortion is legally prohibited. Although state health authorities have championed MVA as the “preferred” PAC technology, the primary donor for PAC, the United States Agency for International Development, does not support the purchase of abortifacient technologies. I conducted an ethnography of Senegal's PAC program between 2010 and 2011. Data collection methods included interviews with 49 health professionals, observation of PAC treatment and review of abortion records at three hospitals, and a review of transnational literature on MVA and PAC. While MVA was the most frequently employed form of uterine evacuation in hospitals, concerns about off-label MVA practices contributed to the persistence of less effective methods such as dilation and curettage (D&C) and digital curettage. Anxieties about MVA's capacity to induce abortion have constrained its integration into routine obstetric care. This capacity also raises questions about what the “job,” PAC, represents in Senegalese hospitals. The prioritization of MVA's security over women's access to the preferred technology reinforces gendered inequalities in health care.

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Decentralizing postabortion care in Senegal with misoprostol for incomplete abortion

Cited by 24 publications

References 8 publications

Comparison of treatment of incomplete abortion with misoprostol by physicians and midwives at district level in Uganda: a randomised controlled equivalence trial

Comparison of treatment of incomplete abortion with misoprostol by physicians and midwives at district level in Uganda: a randomised controlled equivalence trial

Knowledge and provision of misoprostol among pharmacy workers in Senegal: a cross sectional study

“Right tool,” wrong “job”: Manual vacuum aspiration, post-abortion care and transnational population politics in Senegal

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