Misunderstood misoprostol

Cheap drug could prevent millions of deaths from postpartum hemorrhage, but governments are skittish to embrace it because it also can induce abortions.

Published June 5, 2006 3:58PM (EDT)

The San Franscisco Chronicle had a fascinating article on Sunday that belongs in the "Who knew?" department. Misoprostol, an extremely effective drug that can stop postpartum hemorrhages -- the No. 1 cause of maternal mortality, killing an estimated 128,000 women annually -- is not being put to use because of governments' concerns that it causes abortion.

The cheap and safe drug, which was developed in the 1980s to prevent stomach ulcers, works by making the uterine muscles contract, which stops the bleeding. "It is low cost, heat stable, could be given orally, rectally, vaginally. A dream product," according to Dr. Malcolm Potts of the University of California at Berkeley, who along with his wife, political scientist Martha Campbell, has been crusading for the increased use of the drug worldwide. Currently, Thailand and Brazil restrict the use of misoprostol, and it's largely unavailable in Burma and most of Africa.

So the team is campaigning around the globe to encourage more governments to allow its use as a treatment for maternal bleeding. "I think it's immoral not to save women's lives when they are dying from postpartum hemorrhage simply because they might use [a drug] for abortion," Potts told the Chronicle. They might as well outlaw umbrellas, he argues, since those could be used to induce abortion, too.

The biggest challenge is that misoprostol isn't used that widely in the West and hasn't been approved by the U.S. Food and Drug Administration or any European regulatory agency for postpartum hemorrhage. Western doctors opt instead for the costlier oxytocin, which is slightly more effective and has to be refrigerated, which is difficult in remote, poor regions.

Never mind that misoprostol is an excellent drug for medical abortions; the key is to get foreign governments to recognize its other uses. As for concerns that the drug will increase abortion rates, the Chronicle refers to one study conducted in the Dominican Republic that demonstrated that the drug has actually made abortions safer: "since the introduction of misoprostol in 1986, the rate of abortion-related complications decreased from 12 to 2 percent."

It's a strange irony that getting governments to approve a drug that could cause abortions will actually protect women during childbirth. Kudos to this Berkeley couple for fighting for what seems like a medical no-brainer.

By Sarah Elizabeth Richards

Sarah Elizabeth Richards is a journalist based in New York. She can be reached at sarah@saraherichards.com.

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