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ACOG Urges Wider Availability of Misoprostol Internationally to Reduce Maternal Mortality

January 26, 2009

Washington, DC -- Misoprostol is a safe and cost-effective way to provide women with postabortion care services, especially in less developed countries where obstacles to timely health care remain and maternal mortality due to incomplete abortion and miscarriage is high. According to a new Committee Opinion published today, The American College of Obstetricians and Gynecologists (ACOG) supports the increased availability and use of misoprostol as a first-line method for providing immediate postabortion care services and reducing maternal mortality.

The World Health Organization estimates that 67,000 women die each year from abortion or miscarriage-related complications, including retained tissue, hemorrhage, and infection. "Women in low-resource settings and in areas with restrictive abortion laws suffer disproportionately from abortion complications," said Laura Castleman, MD, MPH, MBA, a member of ACOG's Committee on International Affairs who helped develop the new document. "Misoprostol, a medicine that has been shown to effectively treat incomplete abortion or miscarriage, as well as other complications of pregnancy, including postpartum hemorrhage, can help save women's lives."

Postabortion care services, such as evacuation of the uterus, have traditionally involved procedures that require immediate availability of sterilized equipment, operating rooms, or physicians or other skilled personnel. Misoprostol is inexpensive, does not require refrigeration, and can be safely administered by nurses and midwives in an outpatient setting provided they receive appropriate training and support. Unfortunately, it is not widely enough available to meet the existing global need. Increasing its availability to international health systems is key.

"Women need an option within their communities that will allow for immediate medical attention," Dr. Castleman noted. "A woman who is sick and in pain, poor, or otherwise unable to travel may not receive care she needs in time to preserve her health or save her life. Misoprostol provides an important, low-cost alternative to vacuum aspiration, another method that can be used safely in decentralized settings if the necessary instruments and a trained provider are available.

"Ultimately, complications from unsafe abortion are best prevented by expanding access to contraception and safe legal abortion," Dr. Castleman added. "While we hope to see continuing progress in these areas, we also hope the international community will take steps to ensure that misoprostol is routinely available worldwide for use in postabortion care."

Committee Opinion #427, "Misoprostol for Postabortion Care," is published in the February 2009 issue of Obstetrics & Gynecology.

The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.