KUALA LUMPUR, June 7 (C-FAM) The dual use of what many consider an abortion drug came under debate at the just concluded Women Deliver Conference in Kuala Lumpur.
A leading expert on the uses of misoprostol fueled suspicions that the UN's push to make the drug more available is driven by its use in performing abortions. There are further fears it is crowding out other drugs that have been proven to save mother's lives in childbirth.
The doctor introduced as “Miss Misoprostol” shocked her audience and made her co-panelists visibly uncomfortable when she admitted, “We don’t know if misoprostol saves lives.” Beverly Winikoff, President of Gynuity Health Project, was referring to the UN's promotion of the drug as a way to prevent post-partum bleeding, a leading cause of maternal death.
Fellow panelist Ann Starrs, a leading misoprostol promoter, fought back saying the logical conclusion of Winikoff’s remarks would be to stop advocating for the use of misoprostol for bleeding “because we still don’t know enough.” Starrs is president of Family Care International, a group that also promotes abortion. She argued that due to the short attention spans and expectations of policy makers, there needed to be “a little bit of hyperbole.”
After hearing this exchange, one of several doctors in the audience pointed out that misoprostol is already listed as a life-saving commodity for women and children by the United Nations. He quipped, “Is there a difference between ‘lives saved’ and ‘life-saving?’” The moderator interrupted the debate and ended the session ten minutes early.
This discussion of misoprostol largely skirted the topic of abortion, except where promoters of the drug acknowledged that some local community leaders are apprehensive about the double use of the drug.
In contrast, during events promoting the same drug for medical abortion, panelists stressed the importance of registering misoprostol as a treatment for postpartum hemorrhage in order to make it available in countries with laws protecting the unborn.
Although Winikoff was unwilling to affirm that misoprostol “saves lives” in cases of postpartum hemorrhage, in a 2011 meeting she said that when women self-induce abortions with misoprostol distributed by lower-level health workers, “it is not unsafe, and in fact, saves lives.”
Proponents of misoprostol for both postpartum hemorrhage and abortion emphasize “demedicalizing” its use, by putting it in the hands of less skilled health workers and even patients themselves.
At the event, Winikoff compared misoprostol for postpartum hemorrhage with first aid and called it essential at all levels of health care systems. This was in direct contrast to her fellow presenter Hamid Rushwan of the International Federation of Gynecology and Obstetrics (FIGO), who introduced the panel by saying that misoprostol belongs “in lower levels of health systems” where other drugs are not available.
The Women Deliver Conference gave minimal attention to efforts currently underway to increase access to oxytocin, a drug that treats post-partum bleeding with fewer side effects and that does not cause abortion. A representative from PATH, a company that manufactures maternal health products, expressed concern that the hype surrounding misoprostol is taking the focus away from projects such as their initiative to make oxytocin more accessible in low-resource environments.
After Winikoff spoke, a doctor from FIGO in the audience pointed out that with or without high rates of preventive treatment with misoprostol, women’s post-birth outcomes are worse in less-resourced countries, which illustrates the fact that widely available misoprostol is no substitute for improvements to overall health care infrastructure.