Dr Joachim OsurMISOPROSTOL AT GRASSROOTS

Drug AvailabilityMisoprostol is registered for PUD in almost all countries.As a result not strictly controlled.Not always bought on prescription.Long shelf life 7 yearsNo special storage conditionsAffordable

Availability in Chemists in Nairobi

Can Pharmacists Help Women in Need?A number of pharmacy workers lack knowledge of how to terminate pregnancy.While the majority have heard of or sold Misoprostol, they still suggest ineffective remedies for pregnancy termination.

What Would They Provide For Termination of Pregnancy

Can Pharmacy Workers Help Women?Most pharmacy workers were ready to sell the drug in confidence to mystery clientsWhen interviewed, they insisted on patients having a prescription.

On Interview: Pharmacy Workers Say They Ask for Prescriptions

Can Pharmacy Workers Help Women?Even where there is a will to help, knowledge of dosing is seriously lacking.Wrong dosing could lead to complications:Under dose no termination or incomplete abortionFailed termination can lead to foetal malformationsOverdose more side effects, uterine rapture in advanced pregnancy.

Doses Recommended by Pharmacy Workers

FrequencyPercentOD2055.6%20012.8%400 g stat25.6%According to prescription38.3%BD719.4%BD *5/712.8%BD 800 g12.8%Stat dose12.8%Total362.8%

Can Pharmacy Workers Help Women?A number of pharmacy workers give information on the Misoprostol (even if it is wrong information)Others do not give any information for a variety of reasons.

Reasons For Not Giving Information to Women

Importance of Use of Misoprostol at Pharmacy/Community LevelUrugway harm reduction model has shown that use of Misoprostol at community level reduces complications, mortality.

OUTCOMEN%Illegal abortion (but under safer conditions: misoprostol)41261%Continued with the pregnancy173%Spontaneous abortion/other pathologic pregnancies233%They were not pregnant91%Abortion conducted under legal conditions41%No data available (did not return for the after visit")21031%TOTAL675100%What Women Chose to Do After Counseling (Urugway Harm Reduction Model)

Since 2001 the Maternal Mortality Rate in Urugway due to unsafe abortion among women in Public Hospitals decreased by 87%

Grfico5

70

55

40

25

9

M.M.R. due to Unsafe Abortion amongst women without access to private health

Year

Cases

Reasons for visit

REASONS GIVEN BY WOMEN WHO REQUIRED OUR HELP

REASONNUMBERPERCENTAGE

Interference with their project of life21532%

Economic problems15924%

Having already too many children8312%

Lack of life-partner6910%

Fetus mal-formation558%

Pregnancy is the result of rape51%

No data available8913%

TOTAL675100%

Outcome of pregnancies

WHAT HAPPENED AFTER THE "BEFORE VISIT"?

OUTCOMENUMBERPERCENTAGE

Illegal abortion (but under safer conditions: misoprostol)41261%

Continued with the pregnancy173%

Spontaneous abortion and other pathologic pregnancies233%

They were not pregnant91%

Abortion conducted under legal conditions41%

No data available (they didn't return to the "After Visit")21031%

TOTAL675100%

Maternal Mortality 2001-2005

MATERNAL MORTALITY IN URUGUAY 2001 - 2005

YearYearYearYearYearResults of 05Reduction

20012002200320042005related to 01Rate 05-01

Overall Maternal Mortality Rate amongst women without access to private health766860524559%41%

M.M.R. due to Unsafe Abortion amongst women without access to private health70554025913%87%

Countrys M.M.R. due to Unsafe Abortion322825211856%44%

Women arriving to the Emergency Room due to Unsafe Abortion who had to be referred to the Intensive Care Unit141185321%79%

Maternal Mortality 2001-2005

Overall Maternal Mortality Rate amongst women without access to private health

Year

Cases

Overall Maternal Mortality Rate amongst women without access to privat health

Hoja1

M.M.R. due to Unsafe Abortion amongst women without access to private health

Year

Cases

#REF!

Year

Cases

Women arriving to the Emergency Room due to Unsafe Abortion who had to be referred to ICU

Oveall MMR due to Unsafe Abortion in Uruguay

Year

Cases

Countrys MMR due to Unsafe Abortion

Since 2001, the number of women arriving at the Emergency Room of the Public Hospital who had to be referred to the Intensive Care Unit decreased by 79%

Grfico3

14

11

8

5

3

#REF!

Year

Cases

Reasons for visit

REASONS GIVEN BY WOMEN WHO REQUIRED OUR HELP

REASONNUMBERPERCENTAGE

Interference with their project of life21532%

Economic problems15924%

Having already too many children8312%

Lack of life-partner6910%

Fetus mal-formation558%

Pregnancy is the result of rape51%

No data available8913%

TOTAL675100%

Outcome of pregnancies

WHAT HAPPENED AFTER THE "BEFORE VISIT"?

OUTCOMENUMBERPERCENTAGE

Illegal abortion (but under safer conditions: misoprostol)41261%

Continued with the pregnancy173%

Spontaneous abortion and other pathologic pregnancies233%

They were not pregnant91%

Abortion conducted under legal conditions41%

No data available (they didn't return to the "After Visit")21031%

TOTAL675100%

Maternal Mortality 2001-2005

MATERNAL MORTALITY IN URUGUAY 2001 - 2005

YearYearYearYearYearResults of 05Reduction

20012002200320042005related to 01Rate 05-01

Maternal Mortality rate in Public Hospital7668605245=

M. M. due to Unsafe Abortion in Public Hospital705540259

3632272218

M. M. due to Unsafe Abortion in Uruguay3228252118

Women arriving to the Emergency Room due to Unsafe Abortion and had to be referred to the Intensive Care Unit1411853

Maternal Mortality 2001-2005

Maternal Mortality rate in Public Hospital

year

cases

Hoja1

M. M. due to Unsafe Abortion in Public Hospital

Year

Cases

Maternal Mortality due to Unsafe Abortion in Public Hospital

Maternal Mortality rate in Public Hospital

M. M. due to Unsafe Abortion in Public Hospital

M. M. due to Unsafe Abortion in Uruguay

#REF!

#REF!

Year

Cases

Legal ChallengesAbortion still generally restricted in most of Africa.Anglophone countries have similar laws- inherited from the British.Sections of abortion law may impact on community use of MA for termination of pregnancy.

Legal ChallengesA person is not criminally responsible for performing in good faith and with reasonable care and skill a surgical operation upon any person for his benefit, or upon an unborn child for the preservation of the mothers life, if the performance of the operation is reasonable, having regard to the patients state at the time and to all the circumstances of the case.MA is not a surgical procedure but the principle of good faith and reasonable care and skill still applies.

Legal ChallengesAny person who unlawfully supplies to, or procures for any person any thing whatever, knowing that it is intended to be unlawfully used to procure the miscarriage of a woman whether she is or not with a child, is guilty of a felony and is liable to imprisonment for three yearsThe community supplier of MA drugs should have certification by MOH or other agenciesBroad interpretation of the law is necessary so as to spell out legal indications for abortion.

Legal ChallengesAny woman who, being with child, with intent to procure her own miscarriage, unlawfully administers to her self any poison or any noxious things, or uses any force of any kind or uses any other means whatever, or permits any such a thing or means to be administered or used on her is guilty of felony and is liable to imprisonment for seven yearsCountries need to compile adequate evidence to support the scientific use of MA.National standards and guidelines are needed for guidance on MA use both at facility and community levels.

ConclusionMisoprostol is easily available in pharmaciesThis is a window of opportunity for saving women from crude forms of abortion Women have been accessing Misoprostol to terminate pregnanciesInformation given to women by pharmacy workers is not always accurate.Wrong advise on usage of the drug is worrying.

RecomendationsThere is need to train pharmacy workers on pharmacological agents for termination of pregnancy.Use of pharmacies as a channel for Misoprostol could potentially reduce complications of unsafe abortion and should be encouraged.Laws and policies to protect the pharmacist and the woman needed.