The Role and Use of Misoprostol in Private Sector Reproductive Health Services in Cambodia

Misoprostol is an inexpensive synthetic prostaglandin, heat-stable at room temperature, and approved for treatment of gastric ulcers. Off-label use under supervision of health providers has been effective for post-partum hemorrhage and medical abortion in low resource settings. In countries where misoprostol is widely available without proper instruction and supervision of health providers, there may be an increase in complications and misuse, potentially impacting maternal health. In such locations, it may also be difficult to document use. Cambodia is a country with a consistently high maternal mortality rate where the private sector is preferred for reproductive health care services. Abortion is widely available in the private sector, and has been legal since 1997; medical abortion was only introduced in 2007.

Analysis of worldwide sales of misoprostol-containing drugs indicates that the availability of misoprostol is increasing in low-income regions in Asia. Significant increases have been observed in India, Bangladesh and Indonesia, and attributed to the use of misoprostol for obstetric-gynecologic indications. In order to understand the role of misoprostol in private sector use in Cambodia, this study assessed the use of misoprostol the private sector. Perceptions of stakeholders around the availability and distribution of misoprostol in pharmacies and through private providers were investigated. Methods included literature review, key informant interviews with private providers, stakeholders, and drug sellers/pharmaceutical personnel.

Misoprostol-only as a pharmaceutical product does not appear to be very commonly used or sold through the private sector in Cambodia, however, a combination misoprostol-mifepristone drug used for medical abortion is sold widely. The combination is inexpensive; it is produced outside the country and distributed via international partnership. Misoprostol appears to be used occasionally for post partum-hemorrhage and cervical ripening. Further research is needed to assess the potential future role of misoprostol in the country’s overall strategy for addressing high maternal mortality.