Misoprostol use in developing countries: results from a multicountry study

Abstract

Although misoprostol is routinely used for a range of off-label obstetric/gynecologic indications, evidence-based, up-to-date information about safety, effectiveness, and appropriate regimens is not widely available. This information is requested by providers, including pharmacists. Women need information and guidance about its use.

Self-management of medical abortion: a qualitative evidence synthesis

“…Providers were not, however, generally supportive of over-the-counter access to medical abortion drugs. [33][34][35][36] Self-management and selfadministration allowed providers in restricted contexts to distance themselves legally from the abortion. 37,38 Providers in legal contexts could accomplish a similar kind of distancing on moral grounds.…”

“…"late menses" in Brazil). 32,35,36,39 Women in settings where there is little formal public information about abortion (whether in legal or legally-restricted settings), can sometimes be confused about the distinction between misoprostol for medical abortion, emergency contraception and oral contraceptives. 36,38 Women's perceptions of the acceptability of self-management without in-person contact with health professionals depended on: the standard of care and their prior experiences with medical abortion, local notions of professional medical hierarchy, abortion taboos and stigma, and perceptions around the strength, danger and complexity of the drugs.…”

“…32,35,36,39 Women in settings where there is little formal public information about abortion (whether in legal or legally-restricted settings), can sometimes be confused about the distinction between misoprostol for medical abortion, emergency contraception and oral contraceptives. 36,38 Women's perceptions of the acceptability of self-management without in-person contact with health professionals depended on: the standard of care and their prior experiences with medical abortion, local notions of professional medical hierarchy, abortion taboos and stigma, and perceptions around the strength, danger and complexity of the drugs. 20,32,40,41 Providers' perceptions about which healthcare workers should be able to provide medical abortion drugs to women for self-administration varied and depended on: perceptions of the strength of the drugs and hence the expertise in anatomy and physiology needed to explain their full effects; a provider's training in appropriate counselling for abortion; a provider's knowledge of abortionfriendly emergency departments to refer women to in the case of complications; and the client's experience, and therefore trust, of different healthcare workers.…”

“…Critical psychosocial components of counselling included: preparing women for the variability in individual women's physical experiences of medical abortion; the practical and physical difficulties of managing the expulsion process at home; and the fact that most women reported anxiety during the beginning of the medical abortion process but relief at its completion. 20,22,23,30,33,36 Providing adequate counselling in the context of health facilities was, however, seen as time consuming for health professionals and written materials for patients were reported to be underutilized. 19,22,29,33,34 We also derived a number of insights from evidence in both restricted and legal contexts where women self-administer misoprostol through informal networks.…”

“…Nonetheless, some took the risk and counselled women (often based on inadequate training and knowledge) about how to take misoprostol and what to expect, and in some cases even distributed misoprostol. 28,33,36,47 There was distrust, however, among women and providers in pharmacists' ability to properly counsel and administer medical abortion. Distrust arose from a perception of pharmacists as business people, as not holding adequate knowledge, and of being incapable or uninterested in providing follow-up in the case of complications.…”