Expanding access to post-abortion care in Mozambique through the introduction of misoprostol

In Mozambique, abortion-related complications are a major cause of maternal mortality. Misoprostol is an effective, non-surgical alternative to manual vacuum aspiration (MVA) and has the potential to ensure PAC services are widely available. A study was conducted in two districts of Mozambique to demonstrate that misoprostol is feasible at all levels of the health system to treat incomplete abortion, with the goal of increasing access to PAC services. Misoprostol was introduced as a first line treatment of incomplete abortion for cases with a uterine size equivalent to gestational age up to 12 weeks without signs of complications. Data for analysis comes from client records, client exit interviews, and provider interviews. From July 2010-January 2011, 300 women were treated with misoprostol. Maternal and child health (MCH) nurses treated 86% of all cases. At the lowest level facilities, parteira elementars (low-level nurses not trained in MVA) treated 30% of women receiving misoprostol. Client records showed providers gave the correct dose and route of misoprostol in all cases. All providers participating in the provider interview (n=28) agreed or strongly agreed that it was easy to learn how to use misoprostol to treat incomplete abortion, that they felt comfortable using misoprostol to treat incomplete abortion, and that they would recommend misoprostol. This operations research demonstrated that quality PAC services can be provided at all levels of the Mozambican health care system. The introduction of misoprostol expanded access to PAC by building the capacity of providers not previously trained in MVA to treat incomplete abortion.