Africa, Development & Aid, Gender, Headlines, Health, Human Rights, Women's Health

KENYA: Misoprostol Can’t Shake Bad Reputation

NAIROBI, Aug 4 2010 (IPS) - Precious Nabwire nearly died giving birth to her fourth child. If Kenyan gynaecologists have their way, a drug to control bleeding after childbirth will be licensed, offering greater protection to tens of thousands of women facing similar danger.

Her daughter – named Chausiku, “she of the night”, in honour of her arrival just past midnight – was born in Nabwire’s home.

“My labour began in the night and getting to Pumwani Maternity Hospital was out of question because I would have had to use a taxi and this would have cost a tidy sum of 1,000 Kenyan shillings ($12.50 U.S.),” Nabwire recounts.

She sent for a traditional birth attendant who lived nearby. Nabwire was sure the delivery would be as smooth as her first three.

“How wrong I was. The labour, as I predicted, took a short time but then the placenta did not come out. I started getting severe pains but the TBA assured me once the placenta was out they would subside,” Nabwire says.

Drug with many uses

Misoprostol can be used to stop bleeding in a woman who is having a miscarriage; it also helps prompt expulsion of afterbirth. Obstetrician Joachim Osur says the drug is a cheaper option for treatment than surgery.

The drug can also be administered to induce labour when a woman is past her due date or the baby is in distress. In instances where a pregnancy must be terminated to save the life of the mother, misoprostol is again a safer and cheaper alternative to a surgical procedure.

Osur says misoprostol can also be used to dilate the cervix to assist doctors when they need to do an examination.

Twenty minutes later, she was writhing in agony, feeling pain she says was worse than labour. She was bleeding profusely and the look on the birth attendants’ face did little to reassure her.

“Luckily the placenta gave way and the bleeding subsided. I was able to wait until morning before going to hospital. However, by the next day I was very weak and had to be admitted into hospital for one week.”

Postpartum haemorrhage – bleeding after delivery – is one of the top five causes of maternal deaths in Kenya. Across Africa, it is responsible for a third of maternal deaths, according to statistics from USAID.

The Kenya Obstetrics and Gynaecological Society of Kenya (KOGS) is pushing for the registration of the drug known as misoprostol, often referred to by the brand name Cytotec, which they argue could be very effective in controlling postpartum haemorrhage, particularly in limited-resource settings.

According to the last national demographic health survey, released in 2009, 57 percent of women in Kenya give birth at home. Obstetrician and gynaecologist Dr Omondi Ogutu told IPS that were misoprostol made available in community health centres, this drug would help save the lives of millions of women.

“Currently misoprostol is registered for treatment of stomach ulcers but our push is to have the policy on its use expanded to allow for it to be used for gynaecological purposes. This inexpensive drug which retails across the counter for as little as 240 shillings (roughly $3) will help save the lives of many women who die from post-partum bleeding or unsafe abortions,” Ogutu said.

Dr Joachim Osur, a reproductive health expert with Ipas (a non-governmental organization dealing with protection of women’s health), says 20 percent of maternal deaths in Kenya are directly linked to bleeding after delivery. Failure to deliver the placenta like in Nabwire’s case is often fatal.

Research done on the safety and efficacy of misoprostol has shown that it stops the bleeding immediately while helping the uterus expel placenta.

“Misoprostol is a very effective drug; however, controversy surrounding its use to procure abortions has clouded its merits,” says Osur. “Those focusing on its use as an abortion drug are misguided and in the process are causing women of this country to miss out on its many beneficial roles.”

The fears of those reluctant to make the drug more widely available are illustrated by the Namibian experience, where misoprostol is widely known to be used to induce abortions.

Much like in Kenya, abortion in Namibia is restricted to cases of rape, incest or when the life of the woman is in danger. Osur warns that restrictive abortion laws do little to deter women who are keen on obtaining one. An estimated 800 women die from botched abortions in Kenya every day; many dying from haemorrhaging which the drug in question could stop.

“We have no policy surrounding the use of misoprostol because those in the ministry of health who should formulate the policy are jittery based on the issue of abortion. The fear has been that misoprostol will be misused for purposes of procuring abortions,” Osur explains.

He argues that the health ministry should come up with guidelines expanding the approved use of the drug while ensuring it can only be obtained from health facilities, including community clinics where the need is greatest.

“With controlled use, this drug will not necessarily be misused. The reality is if a woman who has delivered takes this drug she faces no risk of bleeding to death. This will be very beneficial for women in far-flung areas who die on the way having been referred from smaller health facilities to larger hospitals for medical attention,” Osur says.

In February, Nigeria became the first African country to register misoprostol for obstetric use. However, the government restricted its use to professional health practitioners in medical centres, ironic in a context where 75 percent of women give birth at home with the help of traditional birth attendants.

Advocates are pushing for the drug to be made available at much lower levels of the public health system, in order for it to have an impact on reducing maternal deaths.

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