Facilitating women’s access to misoprostol through community-based advocacy in Kenya and Tanzania

Francine Coeytaux, Leila Hessini, Nondo Ejano, Albert Obbuyi, Monica Oguttu, Joachim Osur, Kristen Shuken

International Journal of Gynecology & Obstetrics 2014 Apr;125(1):53-5. DOI: 10.1016/j.ijgo.2013.10.004



Objective: To explore the feasibility of educating communities about gynecologic uses for misoprostol at the community level through community-based organizations in countries with restrictive abortion laws.

Methods: In 2012, the Public Health Institute and Ipas conducted an operations research study, providing small grants to 28 community-based organizations in Kenya and Tanzania to disseminate information on the correct use of misoprostol for both abortion and post-partum hemorrhage. These groups were connected to pharmacies selling misoprostol. The primary outcomes of the intervention were reports from the community-based organizations regarding the health education strategies that they had developed and implemented to educate their communities. 

Results: The groups developed numerous creative strategies to reach diverse audiences and ensure access to misoprostol pills. Given the restrictive environment, the groups attributed their success to having addressed the use of misoprostol for both indications (abortion and post-partum hemorrhage) and to using a harm reduction approach to frame the advocacy.

Conclusion: This initiative proves that, even where abortion is legally restricted and socially stigmatized, community-based organizations can publicly and openly share information about misoprostol and refer it to women by using innovative and effective strategies, without political backlash. Furthermore, it shows that communities are eager for this information.

Some details from the main text: The study was conducted in partnership with the Center for the Study of Adolescence (Kenya), KMET (Kenya), Ifakara Health Institute (Tanzania), and the Women’s Promotion Centre (Tanzania). The community-based groups were trained in gynecologic uses of misoprostol and provided with small grants (averaging US $2000 per group) to improve access to misoprostol in their communities.

The groups that received funding reported that the approach gave women and youth opportunities to speak their views on abortion and maternal deaths, and helped break silence and taboos. Others said the initiative cleared misconceptions and myths around abortion and created awareness that women can perform abortions safely and prevent post-partum hemorrhage themselves, with medical back-up only if needed.

The strategies that the groups implemented included flyers such as “Have you missed your period? Are you worried? Come talk to us, we can help”, informational materials, use of social media platforms, handkerchiefs with printed pictorial information, information cards, and a message inside reusable sanitary towel packages.

Community pharmacies and traditional birth attendants were trained in some places to distribute the pills,  and one group contracted matatu (public transport) drivers to deliver misoprostol to women in rural communities. And one group, using its own resources, trained staff to provide counseling and support, formed an alliance with like-minded doctors to help women with any complications, and established a small pharmacy.

Editor’s note: This is an extremely valuable article for innovative and low-cost ideas on community-based medical abortion information and provision. However, it is not open access. The corresponding author is at fcoeytaux@earthlink.net for individual copies.