Misoprostol and Maternal Mortality Reduction in Burkina Faso and Senegal
Why Misoprostol?
Misoprostol, a prostoglandin medication, has been available on the world market since the 1980s for the treatment of gastric ulcers. During the early 1990s, health workers in Brazil began to document women’s off-label use of misoprostol for abortion. Since then, the efficacy and safety of misoprostol for abortion, postabortion care, and treatment and prevention of postpartum hemorrhage have been documented in clinical studies around the world.
The World Health Organization (WHO) has recommended a combination regimen of misoprostol and mifepristone for medical abortion on its List of Essential Medications (LEM) since 2005. The WHO incorporated misoprostol into its LEM for postabortion care in 2010, for prevention of postpartum hemorrhage in 2011, and for treatment of postpartum hemorrhage in 2015. In 2022, the WHO recognized misoprostol alone as a safe method of abortion care in its Abortion Care Guideline.
Relatively inexpensive, easily self-administered or administered by non-physicians, and thermostable, misoprostol has been hailed by global reproductive health experts as a pharmaceutical solution to the persistent problem of maternal mortality from unsafe abortion and postpartum hemorrhage in Africa. At the same time, misoprostol remains politically sensitive precisely because it can be used by non-physicians in non-hospital settings, including for abortion, which is legally restricted in many settings.
Project Objectives
Research Questions
This study aims to explore and compare the social, clinical, professional, technological, and epidemiological dimensions of misoprostol use in Burkina Faso and Senegal.
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• How and where do men and women, as consumers, users, and patients, obtain and use misoprostol?
• How and where do health workers, both in public and private facilities, procure, prescribe, distribute, store, and use misoprostol?
• How and where do national and international NGOs market, promote, distribute and use misoprostol?
• How and where do informal drug sellers obtain and sell misoprostol?
• What is the impact of misoprostol on maternal mortality and morbidity, and how is it measured?
Comparative Ethnographic Research
We conduct comparative ethnographic research on the availability, distribution, purchase, and use of misoprostol by women, health workers, and national and international organizations in Burkina Faso and Senegal. A comparative approach will illuminate how local context intersects with regional and global policies to shape the availability, use, supply, and distribution of misoprostol for approved and unapproved obstetric indications in Burkina Faso and Senegal.
Outreach and Advocacy
We will disseminate results to academic, medical, public health and community settings.
We aim to inform discussions with policymakers, practitioners, and health advocates about reducing maternal mortality from unsafe abortion and postpartum hemorrhage in both countries.
Our Collaboration
Into Women’s Hands/Entre Les Mains Des Femmes is a collaborative initiative funded by the Hewlett Foundation that brings together faculty and students from Joseph Ki-Zerbo University, Cheikh Anta Diop University and Brandeis University to conduct ethnographic research on misoprostol.
Our aim to is offer important information about misoprostol that statistical research does not, such as decision-making processes related to the purchase of misoprostol in health facilities and health systems in general; health workers' experiences with prescribing, storing, and using misoprostol; women's experiences and outcomes related to misoprostol; and the circulation and sale of misoprostol in formal and informal pharmaceutical markets.
