Availability Case Study

In 2011, VSI initiated a comprehensive assessment of the current challenges to ensuring the everyday availability of misoprostol in Tanzania, with the goal of identifying opportunities to improve access over time. This brief summarizes the key findings, recommendations and sample activities to accelerate progress toward increased availability of this essential medicine in Tanzania.

Expanding Access to Postabortion Care Services in Rwanda

This brief summarizes the final results of a comprehensive postabortion care (PAC) pilot program conducted by the Rwanda Ministry of Health and VSI to address maternal deaths due to unsafe abortion. The results demonstrate that enabling mid-level providers at health centers to provide PAC through the integration of misoprostol as a treatment method increases the availability of PAC services and brings them closer to women.

Misoprostol Distribution at Antenatal Care in Tanzania

Final Report in Brief

Final results shared at the dissemination meeting on 3 March 2011 in Dar es Salaam, Tanzania. This brief highlights results from the Ifakara Health Institute and VSI project to protect women from postpartum hemorrhage at home births in four districts of Tanzania.

Expanding Access to Postabortion Care Services in Mozambique

VSI, AMOG and the Bixby Center at UC Berkeley conducted operations research addressing unsafe abortion with misoprostol in Mozambique. This research brief demonstrates that misoprostol is a promising alternative to surgical methods of treating incomplete abortion, and that expanding the level of health facility and provider trained on misoprostol can increase women’s access to these essential services.

Community-based Prevention of PPH with Misoprostol in Mozambique

This brief summarizes the final results a collaborative community-based pilot project of VSI, AMOG, the Bixby Center at UC Berkeley, and PSI. Results show that antenatal care visits and additional community-based strategies, such as TBAs, are key opportunities to reach women with misoprostol and educate them on its use for prevention of PPH.

Scaling up of Misoprostol for Prevention of Postpartum Hemorrhage in 29 Upazilas of Bangladesh

The results from this collaborative operations research project between the ICDDR,B, RDRS, VSI and the Bixby Center at UC Berkeley show that the incorporation of misoprostol into clean delivery kits is a feasible intervention to prevent excessive bleeding after childbirth in the high numbers of women delivering at home in this densely populated country.

Distribution of Misoprostol at Antenatal Care Visits for the Prevention of Postpartum Hemorrhage in Ghana

This brief summarizes the final results from a collaborative project of the VSI/Ghana Health Service pilot program in Ghana to address maternal deaths due to postpartum hemorrhage. The results demonstrate that the distribution of misoprostol through antenatal care visits increased the number of women who received protection from postpartum hemorrhage and is a key opportunity to reach more mothers with safe motherhood messages and ultimately reduce maternal deaths.

Introduction of Misoprostol for Prevention of Postpartum Hemorrhage in Two Kenyan Districts

This brief summarizes the findings of the VSI/KOGS misoprostol for PPH pilot program in Kenya, including that the direct distribution of misoprostol to women through antenatal care visits, as well as through Community Midwives at delivery, increased the number of women who receive protection from postpartum hemorrhage.

Prevention of Postpartum Hemorrhage in Northern Nigeria

Postpartum hemorrhage (PPH) makes a significant contribution to the number of maternal deaths in Nigeria.  This brief summarizes research demonstrating misoprostol is a safe and effective means to control PPH at home births in five communities in Northern Nigeria.

Prevention of Postpartum Hemorrhage in Five Rural Zambian Districts

In Zambia, most of the maternal deaths due to PPH occur in places where there are few skilled birth attendants or a lack of skills or resources to manage bleeding and shock.  This brief summarizes VSI's Zambia program that trained providers on the distribution of misoprostol tablets to women in order to prevent PPH.

Characteristics of Women Seeking Abortion-related Services in Addis Ababa, Ethiopia

Unsafe abortion is one of leading causes of maternal mortality in Ethiopia, accounting for 30% of maternal deaths. With the 2005 revision of the criminal code, Ethiopia has one of the most liberal abortion laws on the continent and abortion-related services, including postabortion care (PAC), are available in both public and private facilities.

Comprehensive Abortion Care Pilot Project in Tigray, Ethiopia

VSI, the Tigray Regional Health Bureau and the Bixby Center at UC Berkeley conducted a pilot program assessing the feasibility of providing comprehensive abortion care at all levels of the health care system in Tigray, Ethiopia, including by Health Extension Workers.

Misoprostol for Postpartum Hemorrhage in Zanzibar

Evaluation and Policy Brief

In Zanzibar, the leading causes of maternal death are hemorrhage (28%) and pregnancy-induced hypertension (17%). Complications from unsafe abortion and miscarriage as well as obstructed labor are also important causes of maternal mortality.

Misoprostol for Treatment of Incomplete Abortion in Madagascar

This brief, written in French, presents the findings from a study on misoprostol for treatment of incomplete abortion and miscarriage in Madagascar which demonstrate the safety and acceptability of the medication-based service. VSI supported partner Marie Stopes Madagascar in its implementation.

Increasing Access to Injectable Contraceptives in Ethiopia

In Ethiopia the unmet need for family planning is one of the highest in the world; 34% of women who desire to control their fertility lack access to a modern form of contraception.

Community-level Prevention of Postpartum Hemorrhage: The Role of Misoprostol

Evaluation in Brief

Evaluation results of introductory trial of community-based use of misoprostol for prevention of postpartum hemorrhage by Health Extension Workers in Ethiopia. This brief presents the findings of the external evaluation and recommendations for scale-up of the successful intervention.

Misoprostol for Safe Motherhood

A simple tablet—misoprostol—can address two of the leading causes of maternal death globally: excessive bleeding after childbirth, or postpartum hemorrhage (PPH), and incomplete abortion and miscarriage.

Misoprostol for PPH: Policy Endorsements

Several organizations including the WHO, the International Confederation of Midwives & International Federation of Gynecology and Obstetrics, and the United States Pharmacopeia have endorsed misoprostol in its use as an effective uterotonic drug to prevent postpartum hemorrhage (PPH).

Misoprostol for PAC: Policy Endorsements

Misoprostol has been endorsed by the WHO, the American College of Obstetricians and Gynecologists, and the International Federation of Gynecology and Obstetrics for treatment of incomplete abortion and miscarriage.

Misoprostol: A Key Resource for Maternal Health Programs

Women are dying in childbirth—and overwhelmingly due to excessive bleeding after childbirth, or postpartum hemorrhage (PPH).  Misoprostol is a heat-stable tablet that is taken after the birth of the newborn to effectively control PPH. Three tablets are taken orally to prevent PPH or five tablets are taken rectally to treat PPH once it occurs.  Misoprostol should be considered a key intervention to curb maternal mortality.

Saving Women's Lives: Ethiopia

In Ethiopia women have a 1 in 40 lifetime risk of dying from maternal causes; an estimated 5,300 mothers die each year due to excessive bleeding after childbirth, or postpartum hemorrhage (PPH), and the vast majority (94%) deliver at home. Complications of abortion also contribute significantly to the high rate of maternal death.

Saving Women's Lives: Kenya

In Kenya women have a 1 in 38 lifetime risk of dying from maternal causes; an estimated 2,500 mothers die each year due to excessive bleeding after childbirth, or postpartum hemorrhage (PPH), and the majority (56%) deliver at home. Complications of abortion also contribute significantly to the high rate of maternal death.

Saving Women's Lives: Mozambique

In Mozambique women have a 1 in 37 lifetime risk of dying from maternal causes; an estimated 1,500 mothers die each year due to excessive bleeding after childbirth, or postpartum hemorrhage (PPH), and half (51%) deliver at home. Complications of abortion also contribute significantly to the high rate of maternal death.

Saving Women's Lives: Tanzania

In Tanzania women have a 1 in 23 lifetime risk of dying from maternal causes; an estimated 3,000 mothers die each year due to excessive bleeding after childbirth, or postpartum hemorrhage (PPH), and the majority deliver at home. Complications of abortion also contribute to the high rate of maternal death.

Saving Women's Lives: Nigeria

In Nigeria - the most populous country in Africa - women have a 1 in 23 lifetime risk of dying from maternal causes; an estimated 23,000 mothers die each year due to excessive bleeding after childbirth, or postpartum hemorrhage (PPH), and the vast majority deliver at home.

Saving Women's Lives: Rwanda

In Rwanda women have a 1 in 35 lifetime risk of dying from maternal causes. Over 1,500 Rwandan women die each year in pregnancy and childbirth. Excessive bleeding after childbirth, or postpartum hemorrhage (PPH), and complications of abortion are the leading causes of these deaths.

La version française se trouve ici.

Saving Women's Lives: Asia

VSI's programs in Asia aim to ensure widespread access to misoprostol and information on its effective use in women's health.

Publications: Misoprostol for the Prevention of PPH

This table shows a summary of selected publications addressing the use of misoprostol for the prevention of PPH.

Publications: Misoprostol for the Treatment of PPH

This table shows a summary of selected publications addressing the use of misoprostol for the treatment of PPH.

Publications: Policy Addressing Misoprostol for PPH

This table shows a summary of selected publications highlighting policy around misoprostol for PPH.

Publications: Misoprostol for Treatment of Incomplete Abortion and Miscarriage

This table shows a summary of selected publications addressing the use of misoprostol for the treatment of incomplete abortion and miscarriage.

Publications: Misoprostol for Medication Abortion

This table shows a summary of selected publications addressing the use of misoprostol for medication abortion.

Availability Program - Tanzania

In 2011, VSI launched a program to assess the availability of misoprostol in Tanzania with a goal of improving women's ability to access this essential medicine when and where they need it. This program brief presents accomplishments to date in Tanzania as well as the way forward for improved availability of misoprostol tablets.