Complications with use of misoprostol for abortion in Madagascar: between ease of access and lack of information

Abstract

Objectives: To learn what complications some women experienced in Madagascar following use of misoprostol for abortion and what treatment they received post-misoprostol use.

Study design: This was a qualitative study in 2015-16 among women who had experienced complications after use of misoprostol, with or without additional methods, for abortion, what information they received before use, what dosage and regimens they used, what complications they experienced and what treatment they received post-use. We initially conducted in-depth, semi-structured interviews with 60 women who had undergone an abortion that resulted in complications. The results presented here are based on interviews with the sub-set of 19 women who had used misoprostol.

Results: The 19 women were aged 16-40, with an average age of 21-26 at interview and average age of 18-21 at abortion. To obtain an abortion, they sought advice from partners, friends, family members, and/or traditional practitioners and healthcare providers. Misoprostol was easily accessible through the formal and informal sectors, but the dosages and regimens the women used on the advice of others were extremely variable, did not match WHO guidelines, and were apparently ineffective, resulting in failed abortion, incomplete abortion, heavy bleeding/hemorrhage, strong pain, and/or infection.

Conclusion: This study provides data on complications from the use of misoprostol as an abortifacient in Madagascar. Healthcare providers need training in correct misoprostol use and how to treat complications. Law and policy reform are needed to support such training and to ensure the provision of safe abortion services in the public health system.

Implications: Healthcare providers who provide abortion care and treatment of abortion complications need training in correct misoprostol use and treatment of complications. Women and pharmacy workers also need this information. Law and policy reform are needed to allow training and provision of safe services. Further research is needed on the extent and impact of incorrect misoprostol administration.

Comment:Although a combination of mifepristone and misoprostol is the best and WHO-recommended regimen for safe medical abortion, in many places mifepristone is not available, so providers rely on misoprostol only. In which case training on the optimal use of misoprostol, possible side-effects and how to deal with them is essential, as this publication shows. If abortion is legal, even for a few indications, and if misoprostol is available, the health care system has an obligation to make that training available. (HMV)