MDG 5, HUMAN RIGHTS, AND MATERNAL HEALTH IN AFRICA
induced maternal deaths due to its advantage over competing drugs. 50
Unlike other PPH drugs, such as injectable oxytocin and ergometrine,
which require refrigeration and administration by health care
professionals, 51 misoprostol comes in a tablet form, does not need to be
refrigerated, is inexpensive, and can be self-administered. 52
Self-administration is particularly significant as most fatal PPH occur in home
deliveries without the assistance of SHP.
The real impact of this drug will, however, depend on the rapidity of its
introduction and availability in countries struggling with PPH. Because
most victims of PPH are poor, rural women, strong and sustained awareness
campaigns as well as financial assistance toward the purchase of the drug
must form an integral part of national plans to address this challenge.
Another difficulty that might hamper widespread availability of misoprostol
is its use as an abortifacient. Even though the drug is ”the most important
development in women’s health for decades” in terms of PPH management,
support for the use of misoprostol may not be forthcoming for those with
moral objections to abortion. 53 Furthermore, although there seems to be
widespread support in the scientific community for self-administration of
misoprostol, 54 WHO is strongly opposed, citing safety concerns and
absence of rigorous studies showing that self-administration has no adverse
consequences. 55 Nonetheless, countries are forging ahead with approving
the use of the drug for PPH management. 56
B. Early Marriage and Teenage pregnancy
Aside from hemorrhage, another major contributory factor to the
deteriorating state of maternal health in Africa is early marriage and teenage
pregnancy. Despite gains in education and massive attempts at social
50. WHO, DEP’T OF REPROD. HEALTH & RESEARCH, CLARIFYING WHO POSITION ON
MISOPROSTOL USE IN THE COMMUNITY TO REDUCE MATERNAL DEATH (2009) [hereinafter
WHO POSITION ON MISOPROSTOL USE], available at http://whqlibdoc.who.int/hq/2010/
WHO_RHR_ 10. 11_eng.pdf.
51. Z. Alfirevic et al., Prevention of Postpartum Hemorrhage with Misoprostol, 99
INT’L J. OBSTET. & GYNECOL. S198, S198 (2007).
52. Amy Jadesimi & Friday E. Okonofua, Tackling the Unacceptable: Nigeria Approves
Misoprostol for Postpartum Haemorrhage, 32 J. FAM. PLANN. REPROD. HEALTH CARE 213,
53. Carolyn Abraham, When health and moral values collide, GLOBE & MAIL (updated
Aug. 23, 2012), http://www.theglobeandmail.com/news/world/when-health-and-moral-
54. Malcolm Potts et al., Maternal Mortality: One Death Every 7 Min, 375 LANCET
1762, 1762–63 (2010).
55. WHO POSITION ON MISOPROSTOL USE, supra note 50.
56. See Campbell & Holden, supra note 49.