Business Daily (Nairobi)

13 June 2011

The Kenya Obstetrical and Gynaecological Society has ignited a debate over abortion with its push to have the controversial Misoprostol tablets dispensed to pregnant women with an aim of curbing bleeding after birth.

The director of public health, Dr Shahnaz Shariff, said the drugs would provide an option for treating the bleeding, for which an injectable drug, oxytocin, is the primary mode of treatment.

There have been fears that the tablets would be abused to procure abortion.

“We are yet to establish the facilities where the drug will be rolled out as a back-up treatment. The primary treatment remains oxytocin; there will be no need to dispense it in all the facilities,” he said.

Misoprostol has been in the market for a while and has been used to stop post-birth bleeding and clean the uterus especially where unsafe abortions have taken place. It can also be used to terminate pregnancies.

Some doctors have accused the society of seeking to legalise abortion in the pretext of saving women’s lives. “I can’t imagine a situation where vaginal bleeding is so life-threatening that you can’t make it to the nearest health centre or hospital,” said Dr Caesar Mungatana, a Nakuru-based surgeon. “How much blood does an average healthy human being need to lose before his life is in danger? Perhaps 30 per cent and that can only happen if your blood vessels are cut and in such a situation one is likely to die in 10 or 15 minutes. Bleeding in the womb is as life threatening but some of the gynaecologists are pro-abortion.”

Postpartum haemorrhage (PPH) is the leading cause of maternal mortality. The situation is worse in Kenya where more than half of pregnant women give birth outside health facilities because of inaccessibility of health facilities, cultural beliefs and high cost of health care. The government intends the drug to reach women in areas where oxytocin is not available. Because of its tablet form, misoprostol is easier to administer even for attendants with average skills.

About 8,000 women die in Kenya from pregnancy and child-birth complications every year, a third of them attributed to unsafe abortions. The gynaecological and obstetrics society (KOGS) says the tablet would help contain the increasing maternal deaths in rural areas and slums.

According to Dr Dominic Karanja who chairs the Pharmaceutical Society of Kenya, if the use of the drug is to be adopted, it should be accompanied by relevant training.

“Midwives, especially in rural areas do the work gynaecologists are supposed to do as most of them are found in major towns only. It would be wise to train midwives on how to administer the drug so that it does not have negative impacts on the patient,” he said.

Safe births in Kenya is difficult because of, among others, culture that hinders women from seeking health care during pregnancy and a shortage of trained health workers.

At least 105,000 community health workers are needed to attend to more than half of children and mothers who cannot access a health facility at a radius of five kilometres.

An associate professor of obstetrics and gynaecology at the University of Nairobi Joseph Karanja says the drugs will save thousands of pregnant women in remote and areas who die due to lack of doctors and health facilities.

“In some parts like North Eastern we have less than 10 doctors and yet we have a dozen midwives spread all over who could be trained on how to administer the drugs,” he said.

While the debate on the adoption of Misoprostol rages, controlling unwanted pregnancies would reduce demand for unsafe abortion, other doctors say. “The government needs to urgently revive the family planning services to stem the upsurge of unwanted pregnancies that leads to abortions,” said Dr Hillary Mabeya, a lecturer at the Moi University School of Medicine.