Online Program

Distribution of misoprostol in post-abortion care services in La Paz, Bolivia

Monday, November 4, 2013 : 2:30 p.m. - 2:50 p.m.

Manjot Multani, MSPH, School of Health Sciences and Education, Touro University-California, Vallejo, CA
Background The two major causes of maternal mortality worldwide are unsafe abortion and post-partum hemorrhage, 13% and 25% of maternal deaths respectively. Misoprostol is a drug used to prevent and/or treat PPH and to safely evacuate the fetus in the first trimester. In most countries, the drug has been approved to prevent gastric ulcers and is used off-label to terminate pregnancy. It is debatable whether misoprostol is more effective than oxytocin in treating PPH. In countries where abortion is illegal, as in Bolivia, the off-label use of misoprostol is controversial. The purpose of this study was to investigate the use of misoprostol in Post Abortion Care services (PAC) in La Paz, Bolivia. PAC services are nationwide programs implemented in developing countries with restrictive abortion laws to offer women obstetric and gynecological care in a safe, clinical environment. Methods Data for this study were collected through qualitative interviews with a convenience sample of five key informants. The qualitative data gathered was analyzed using thematic analysis. Results According to the respondents in this study, Bolivia's restrictive abortion laws, which permit abortion only in cases of rape, incest or when the mother's health is in danger, make the off-label use of misoprostol more frequent, both for evacuating the fetus, and for preventing or treating PPH. Discussion Participants noted that if the medication became more widely available and registered for more than just PPH treatment and prevention, it has the potential to impact maternal mortality rates significantly in Bolivia.

Learning Areas:

Assessment of individual and community needs for health education
Clinical medicine applied in public health
Diversity and culture
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Analyze and discuss the distribution of misoprostol in post-abortion care services in La Paz, Bolivia where restrictive abortion laws exist.

Keyword(s): International Reproductive Health, Maternal Care

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Off-label use of misoprostol for control of post-partum hemorrhage in Bolivia. Does not include any product under investigational use.

Qualified on the content I am responsible for because: I have been the principal investigator and recorded all responses myself pertaining to this study. I have experience in maternal and child health with this research and have on-going participation in international health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.