In many low resource countries with limited access to health care services and few trained surgical abortion providers, medical methods of abortion promise to help reduce maternal morbidity and mortality. Furthermore, many women prefer abortion induced by drugs to surgery. Enabling women to choose an alternate method of abortion will improve access to safe services and increase satisfaction.
Of all recognized pregnancies, 15-20% are spontaneously miscarried and an additional 22% end in induced abortion. Incomplete abortion occurs when products of conception are partially expelled from the uterus; and either spontaneous or induced pregnancy loss can result in incomplete abortion. Women seeking care following incomplete abortion are faced with the inadequacy of existing safe abortion and postabortion care services. In countries where access to safe abortion services is restricted, abortions may be performed by unskilled providers in poor conditions and incomplete abortion is of particular concern.
Pre-eclampsia and eclampsia are serious conditions unique to pregnancy and resulting in 40,000-80,000 deaths worldwide each year. In resource-poor settings, treating pre-eclampsia/ eclampsia presents many challenges. Magnesium sulfate, an inexpensive drug, is an effective treatment but has limited availability in the developing world and is potentially harmful to the pre-eclamptic woman and her fetus if its administration is not carefully monitored. For this reason, additional research is needed on new approaches for use of this simple technology where clinical and human resources are limited.
Postpartum hemorrhage (PPH) is the leading cause of maternal death in the developing world. The administration of oxytocin after childbirth has been shown to reduce postpartum bleeding and is the standard treatment for PPH. However, several factors can complicate its safe and effective use in resource poor settings. For instance, oxytocin requires refrigeration, sterile equipment for safe injection, and trained medical providers for administration. Since misoprostol has similar uterotonic effects as standard injectable oxytocics, its use has been investigated as an alternative for the prevention and treatment of postpartum bleeding.
AIDS, the deadly syndrome caused by the Human Immunodeficiency Virus (HIV) is perhaps the highest-profile health problem of recent decades. Despite the emergence of antiretroviral drugs, the disease continues to ravage populations worldwide, disproportionately in sub-Saharan Africa. For both biological and cultural reasons, the disease hits hardest among women and the young: WHO estimates that 30% of the 40 million people living with HIV worldwide are between the ages of 15 and 24, and that, in sub-Saharan Africa, there are 13 women living with HIV for every 10 men.