As FHD´s decision for expanding misoprostol distribution program came only after the Ministry of Finance (MoF) sealed this fiscal year´s financial arrangement, this controversial drive has not been incorporated into the yet-to-be-tabled new budget. [break]
However, according to Dr Shilu Aryal, the coordinator of Safe Motherhood Program (SMP), FHD will start distributing misoprostol pills in more 15 districts from this year with support from donors.
"The expanded program for distributing misoprostol will probably be incorporated in next year´s budget," Dr Aryal said. Previously, following the success of misoprostol in Banke district where it was introduced in a pilot project, FHD had been distributing this pill in five districts for the past few years.
As misoprostol proved its efficacy in stopping excessive bleeding after child delivery, FHD decided to scale up this program beginning this year.
Locally known as Matri Suraksha Chakki (MSC) in Nepal, FHD has been distributing misoprostol pills through Female Community Health Volunteers (FCHVs) to pregnant women. Pregnant women are instructed to use misoprostol only if they bleed excessively following pregnancy complications during delivery at home.
"Our policy is to provide the service of Skilled Birth Attendants (SBAs) to all pregnant women," Dr Aryal said. "Unfortunately, a majority of pregnant women in villages do not have access to the service provided by SBAs. They still deliver their babies at homes. In such conditions, misoprostol pills can come handy if a pregnant woman starts bleeding profusely while delivering her baby."
Risky pill
In spite of side effects like nausea, vomiting, diarrhea and fever, Misoprostol is effective in stopping excessive bleeding.
However, with the effectiveness of misoprostol comes a plethora of risks associated with its misuse. In the case of FCHVs´ failures in making pregnant women, especially illiterate ones in villages, adequately aware of the risk of the misuse of misoprostol pills, it could lead to miscarriage as well as mother´s death.
A family health expert said, "Misoprostol is a very dangerous pill. The government should introduce a set of precautionary measures well before scaling up its distribution. Otherwise, chances of untoward consequences are very high." He said family health experts even within FHD were divided when the decision of expanding the program of misoprostol distribution was taken.
But Dr Aryal dismissed it. She said FHD unanimously decided to expand this program. However, she admitted, "Yes, misuse of misoprostol pills could be dangerous. But we are cautious to prevent its misuse. We have instructed FCHVs accordingly."
Besides stopping bleeding, misoprostol can be used in inducing labor pain and aborting pregnancy as well. Many countries including Nepal have banned its use for abortion or inducing labor. Some family health experts say misoprostol can be misused for inducing labor pain out of sheer ignorance.
Similarly, if a pregnant woman delivers her baby with no complications and hands over pills to others, chances of its use for illegal purpose are very high.
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