Facilitating women's access to misoprostol through community-based advocacy in Kenya and Tanzania.
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 postpartum 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 postpartum hemorrhage) and to using a harm reduction approach to frame the advocacy.


CONCLUSIONS
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.
Public Health Institute, Oakland, USA. Electronic address: fcoeytaux@earthlink.net.
Francine
F
Coeytaux
Ipas, Chapel Hill, USA.
Leila
L
Hessini
Women's Promotion Centre, Kigoma, Tanzania.
Nondo
N
Ejano
Centre for Study of Adolescence, Nairobi, Kenya.
Albert
A
Obbuyi
KMET, Kisumu, Kenya.
Monica
M
Oguttu
Ipas, Nairobi, Kenya.
Joachim
J
Osur
Public Health Institute, Oakland, USA.
Kristen
K
Shuken
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000600:supply & distribution; D000028:Abortion, Induced / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006266:Health Education / Q000379:methods; D006297:Health Services Accessibility; D006801:Humans; D033181:Information Dissemination / Q000379:methods; D007630:Kenya; D016595:Misoprostol / Q000008:administration & dosage* / Q000600:supply & distribution; D010344:Patient Advocacy; D006473:Postpartum Hemorrhage / Q000188:drug therapy; D011247:Pregnancy; D013636:Tanzania
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
Abortion; Advocacy; Hemorrhage; Misoprostol; Pharmacy access; Postpartum