Implementation barriers or gaps in misoprostol use for post-abortion care and post-partum hemorrhage prevention in developing countries : a systematic review

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


In developing countries-Post-partum hemorrhage (PPH) and abortion related complications remained to be the foremost causes of maternal mortality. Implementing misoprostol for Post abortion care (PAC) and PPH prevention will play a considerable role in lowering national maternal mortality and morbidity rates. This systematic review (SR) will help in identification of possible implementation gaps or barriers in misoprostol use for prevention of PPH and effective management of PAC services in developing countries. Methods: This study is a systematic review of published qualitative and quantitative literature on misoprostol in developing countries. Documents were include local and international peer reviewed articles and reports on misoprostol implementation. PubMed, Google Scholars and Science direct databases were used along with Grey literature and manual search using terms "implementation gaps", "misoprostol use", "postpartum hemorrhage", "post-abortion care" and "developing countries. Eligibility criteria were set to select the article for review. Filters for article type, years of publication and humans pecies was applied to make the search more specific. Results: Systematic review findings have identified implementation gaps or barriers in misoprostol use for prevention of PPH and management of PAC services in developing countries. Findings were categorized into six broader thematic areas. Among most notifiable barriers or gaps include inconsistency in supplies and its distribution, inadequate staffing, lack of knowledge of providers and end users, no registration of drug, fear and apprehensions related to its perceived misuse at policy and provider level, Lack of access to misoprostol and lack of integration of misoprostol with Basic package of health services/ health care resources. Conclusion: Although Misoprostol has shown significant impact to prevent PPH and to provide safe PAC services in context to developing countries but the significant impact in term of maternal indicators would only be achieved by bridging these identified gaps and overcoming barriers with strong advocacy efforts, providing enabling environment, adeqUate training and continuous support to service providers and use for guidelines and protocols for successful implementation. This review will possibly assist governments, NGOs and health care providers to effectively implement misoprostol, and ultimately save women's lives. Key words: Misoprostol, post abortion care, postpartum hemorrhage, developing countries.

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