title: Misoprostol and declining abortion-related morbidity in Santo Domingo, Dominican Republic: a temporal association.
abstract: OBJECTIVE
  To validate anecdotal reports that abortion-related complications decreased in the Dominican Republic after the introduction of misoprostol into the country.
  
  
  METHODS
  Retrospective records reviews and cross-sectional surveys, interviews and focus groups.
  
  
  METHODS
  Family planning clinics, pharmacies, door-to-door canvassing and a tertiary care maternity hospital in Santo Domingo, Dominican Republic.
  
  
  METHODS
  Women of reproductive age in Santo Domingo, Dominican Republic.
  
  
  METHODS
  Qualitative and quantitative methods were used. Individual interviews and focus groups of reproductive health professionals, non-governmental organisation leaders and women's group leaders (n= 50) were conducted to discover the role of misoprostol in the Dominican Republic. Local women (n= 157) were surveyed to determine their knowledge of misoprostol as an abortifacient and mystery client visits were made to 80 pharmacies in order to purchase misoprostol without a prescription. Sales data were obtained that documented when misoprostol was introduced to the Dominican Republic pharmacies. Hospital admissions for abortions from the prior eight years were reviewed and hospital emergency room consultation ledgers of 31,190 visits for the period 1994-2001 were reviewed for abortion complications.
  
  
  METHODS
  Frequencies of maternal morbidities and knowledge of misoprostol.
  
  
  RESULTS
  Mystery clients purchased misoprostol without a prescription in nearly 64% of pharmacies; staff provided little additional information or counselling. Reliable sales data documented the introduction of misoprostol in 1986. Abortion complications decreased from 11.7% of abortions in 1986 to 1.7% in 2001. The majority of professionals interviewed felt that knowledge of these findings should be made public.
  
  
  CONCLUSIONS
  The data were of too poor quality to validate the verbal reports reliably, but misoprostol appears to have been widely used over a period when abortion-related morbidity fell. It remains plausible that the use of misoprostol contributed to the reduction.
authors.affiliation: Women's Global Health Imperative, Department of Obstetrics and Gynecology, University of California, San Francisco, California 94105-3444, USA.
authors.forename: Suellen
authors.initials: S
authors.lastname: Miller
authors.forename: Tara
authors.initials: T
authors.lastname: Lehman
authors.forename: Martha
authors.initials: M
authors.lastname: Campbell
authors.forename: Anke
authors.initials: A
authors.lastname: Hemmerling
authors.forename: Sonia Brito
authors.initials: SB
authors.lastname: Anderson
authors.forename: Hector
authors.initials: H
authors.lastname: Rodriguez
authors.forename: Wilme Vargas
authors.initials: WV
authors.lastname: Gonzalez
authors.forename: Milton
authors.initials: M
authors.lastname: Cordero
authors.forename: Victor
authors.initials: V
authors.lastname: Calderon
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000191:economics; D000028:Abortion, Induced / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D000328:Adult; D003430:Cross-Sectional Studies; D004293:Dominican Republic / Q000453:epidemiology; D016527:Drug Costs; D005260:Female; D006801:Humans; D008875:Middle Aged; D016595:Misoprostol / Q000191:economics; D011247:Pregnancy; D012189:Retrospective Studies
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol