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

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.