The Domestication of Misoprostol for Abortion in Burkina Faso: Interactions Between Caregivers, Drug Vendors and Women

Misoprostol has been hailed as a revolution within global maternal health research and policy communities because of its potential to reduce maternal mortality from post-partum haemorrhage and unsafe abortion, allowing relatively safe abortion in legal and illegal settings. However, we know little about how women who want to use misoprostol access it to induce abortion. Based on 15 months of ethnographic fieldwork in Ouagadougou, Burkina Faso, this chapter describes and analyses how women gain access to misoprostol to induce abortion within a setting where induced abortion is legally restrictive and where the legal use of misoprostol is limited to post-abortion care and post-partum haemorrhage. The findings show that women seeking abortions in Ouagadougou are able to access misoprostol through unofficial channels, specifically through health workers and drug vendors. While this unofficial use of misoprostol is relatively safer, and more affordable than other options, access is not equally distributed and the cost women pay for the drug varies significantly. While women with strong social networks and financial resources can access misoprostol easily, other women who do not have money to buy misoprostol may become victims of sexual violence from men from whom they seek abortion services. In Ouagadougou, access to abortion with misoprostol is shaped by health workers and the social and economic conditions of the women who seek it. The study uses the concepts of ‘pharmaceutical diversion’ and ‘domestication’ as adjacent analytical frameworks to emphasize the changing pattern of access to misoprostol. The chapter introduces the importance of looking at safe access to safe abortion.

Misoprostol-induced Coronary Vasospasm Complicated by Takotsubo Cardiomyopathy and Cardiac Arrest

Misoprostol is a synthetic E1 prostaglandin commonly used to induce abortion in the United States and elsewhere. There is limited literature on the cardiovascular adverse effects of misoprostol, and, to the best of our knowledge, very few such events have been reported. We describe the case of 52-year-old woman who was given misoprostol for cervical softening before endometrial ablation and experienced a cardiac arrest due to coronary vasospasm. She was successfully resuscitated and echocardiography showed features consistent with Takotsubo cardiomyopathy. Coronary angiography revealed coronary artery spasm which responded to nitroglycerin. Our case adds to the limited literature on this life-threatening adverse event of misoprostol.

“Remedies” and Remedies

Young people sought to resolve the challenge of untimely pregnancies in various ways. Male and female partners were involved with efforts to terminate the pregnancies—in effect, to induce abortion. Women’s reproductive health was potentially endangered both by the morbity of pregnancies and childbirth in pre-modern societies and by the potential risk of the “remedies” associated with attempting to end a pregnancy. A host of clergy, legal specialists, and friends and neighbors sought to support young couples in other ways by mediating informal settlements with the goal of ensuring safe deliveries and the welfare of the babies. In all of these efforts, working communities saw out-of-wedlock pregnancy as an inevitable if hopefully occasional occurrence to be managed pragmatically to secure the futures of all involved.

Determinants of Choice of Abortion Methods among Women in Ghana; Does Knowledge on legality of Abortion Matter?

Objective This study therefore examines the role knowledge on legal abortion and other factors play in the choice of abortion methods among women within a ten-year period. Design The study use data from the 2007 and 2017 Ghana Maternal Health Surveys. A total sample of 2,432 women aged 15-49 whose activities related to their most recent induced abortion were selected. This study, however, limits the analysis to a subpopulation of women who have terminated a pregnancy between 2002 to 2007 and 2012 to 2017. The made use of binary logistic regression analysis to show the relationship between choice of abortion methods and knowledge of legality of abortion. Setting Ghana Participants Women who had practice induce abortion Main outcome measure Choice of Abortion methods Results Likelihood of unsafe abortion practices was high among women who had knowledge on legality of abortion, women with no formal education, single women, rural women and women whose partners did not know about the pregnancy. Conclusion Increasing knowledge of legal status on abortion among women corresponded with an increased in the use of unsafe abortion methods over the decade has implication for poor reproductive health outcome and increased maternal mortality among women in Ghana.

Uptake of Misoprostol among women seeking abortion in Accra, Ghana

Background Unsafe abortions remain one of the key contributors to maternal mortality. The World Health Organisation (WHO) has recommended misoprostol as a safe abortifacient which has become a popular over the counter self-administered abortifacient in Ghana. This study sought to examine the prevalence of misoprostol uptake and model the factors associated with its uptake among 698 women seeking abortion services in the Accra Metropolis of Ghana. Methods Univariate and multivariate analysis were done. The multivariate analysis was done using binary logistic regression to model the factors associated with misoprostol uptake and results are presented as adjusted odds ratios (AORs) with their 95% confidence intervals (CIs). P < 0.05 was considered statistically significant. Results The results showed that the prevalence of misoprostol uptake was 20.8%. The regression analysis showed that women who were cohabiting had higher odds [AOR=1.91, CI=1.16-3.16] of using misoprostol compared to women who were single. In relation to miscarriage and use of misoprostol, it was found that women who experienced one [AOR=0.27, CI=0.15-0.49] and 2 or more miscarriages [AOR=0.25, CI=0.07-0.85] had lower odds of using misoprostol compared to those who have never experienced any miscarriage Conclusion The prevalence of misoprostol uptake among women seeking abortion services in Accra Metropolis is relatively high. Marital status and previous history of miscarriage are associated with misoprostol uptake. Although proven effective by various studies and recommended by the WHO, it is imperative to consider these factors in the education of women on the use of misoprostol as well as designing programmes to target women who are inclined to induce abortion in Ghana.

A Pill in the Lifeworld of Women in Burkina Faso: Can Misoprostol Reframe the Meaning of Abortion

In Burkina Faso, induced abortion is socially stigmatized, condemned, disapproved and legally restricted to cases of rape, incest, fetal malformation or endangerment to the life of the mother. Many women often resort to unsafe procedures to induce abortion, which puts their health at great risk. Misoprostol, which is officially restricted to the treatment of postpartum hemorrhage or post-abortion care, is also used illegally by women to terminate their pregnancies. Misoprostol represents an addition to the existing abortion methods, such as vacuum aspiration, which health workers have often used to induce abortion clandestinely. Many women also use misoprostol to self-induce abortions, replacing abortifacients such as herbal teas, potions, high doses of antimalarial drugs, or bleach. Despite the changes that occur in abortion access due to the use of misoprostol, little is known about what the drug means to its users and how this meaning can in turn influence the meaning of abortion. The aim of this paper is to describe how the use of misoprostol to terminate pregnancy contributes to changing women’s perception of the meaning of abortion. This paper is based on ethnographic fieldwork conducted between March 2016 and February 2017 in the city of Ouagadougou, Burkina Faso. By examining the relation between the use of misoprostol and the meaning that women give to abortion, this study found that women experience abortion either spontaneously or using emergency contraception with misoprostol. Through the experience of women, this paper claims that the meaning of abortion should be seen as a social construct and fundamentally rooted in individual practices and experiences rather than being subject to dichotomist global discourse.

Tamoxifen administration in pregnant mice can be deleterious to both mother and embryo

Since it was introduced 20 years ago, tamoxifen-inducible genetic recombination in vivo has become a standard tool in many fields. This technique has great utility, allowing precise temporal and spatial gene recombination mediated by expression of a Cre recombinase-oestrogen receptor hormone binding domain fusion protein. It is frequently used in developmental biology, either for accurate spatio-temporal gene deletion or for lineage-labelling. Administration of high doses of tamoxifen can rapidly induce abortion in pregnant mice but this can be partially overcome by progesterone co-administration. However, administration of tamoxifen to pregnant mice early in pregnancy may have potentially lethal effects on the mother independently of abortion, and can also severely perturb embryonic development. Despite this, only a few published studies mention this fact in passing, and standard parameters for successful or unsuccessful use of tamoxifen in pregnant mice have not been reported. Therefore, in the interests of providing a framework for more humane animal research, we describe our experiences of tamoxifen administration during early gestation in mice. These observations should assist the design of future studies in accordance with the principles of the three Rs (Replacement, Reduction and Refinement of Animals in Research).

First Trimester Rupture of Scarred Uterus After Use of Mifepristone, Misoprostol A-Case Report.

Uterine rupture is a disastrous obstetric complication, occurring mostly in second and third trimesters. The risk of uterine rupture markedly increases with previous uterine surgeries. Termination of early pregnancy failure by misoprostol is common. However, its use in women with scarred uterus is speculative and usually puts the obstetricians in a stressful condition. Here we present a case of rupture of a scared uterus in the first trimester after using mifepristone and misoprostol. A 25 years old parous lady presented with uterine rupture after taking mifepristone and misoprostol by herself to induce abortion for unwanted pregnancy. Immediate laparotomy was done and the defect was repaired. Termination of pregnancy in a woman with scarred uterus by mifepristone and misoprostol can lead to uterine rupture. It should be used cautiously under close supervision or other routes (vaginal or oral). KYAMC Journal Vol. 10, No.-1, April 2019, Page 57-59