Cheap drug to make childbirth safer in poor countries

The results of a clinical trial in rural India published last week in The Lancet medical journal indicate that misoprostol reduced the incidence of postpartum haemorrhage by almost half.

Death due to postpartum haemorrhage accounts for almost 30 percent of maternal fatalities in India, where nearly half of all births take place in the home or in facilities without a trained gynaecologist or obstetrician in attendance.

“The researchers showed that giving women misoprostol after birth is a safe, inexpensive means of preventing postpartum haemorrhage from occurring,” says Elias Zerhouni, director of the United States National Institutes of Health, which was involved in the study. “This advance has the potential to save thousands of lives each year.”

The trial involved 1620 female volunteers, half of whom received a placebo. The other half received 600 micrograms of misoprostol, taken by mouth. Average blood loss was found to be significantly lower in the misoprostol group.

The team led by Stacie Geller ‘ director of the National Centre of Excellence in Women’s Health at the University of Illinois in the US ‘ says the results show that misoprostol is safe, effective and inexpensive for women giving birth in resource-poor settings. The researchers say it is “currently the only available pharmacological option for preventing postpartum haemorrhage and reducing postpartum blood loss in these communities”. Last week, US-based researchers writing in the British Medical Journal said if misoprostol had been implemented earlier instead of waiting for it to go through clinical trials in resource-poor settings, many women’s lives could have been saved.

A major concern is the potential for the misuse of misoprostol in India, says Kamala Ganesh, former professor of gynaecology at the Maulana Azad Medical College, Delhi.

The drug is available, although illegally, as an over-the-counter pill. Approved for use in India in 2002, it is only supposed to be taken under medical supervision, yet it is sold in several pharmacies.

Ganesh says misoprostol could be used by families to coerce women into selectively aborting female fetuses. Misoprostol has, in any case, had a chequered history in India. Women’s groups and activists protested against introducing it as an abortion pill, citing side effects including severe cramps and vaginal bleeding. ‘ SciDev.Net.

October 2006
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