Abstract:
BACKGROUND : In Malawi, abortion is only legal to save a pregnant woman’s life. Treatment for complications after
unsafe abortions has a massive impact on the already impoverished health care system. Even though manual vacuum
aspiration (MVA) and misoprostol are the recommended treatment options for incomplete abortion in the first trimester,
surgical management using sharp curettage is still one of the primary treatment methods in Malawi. Misoprostol
and MVA are safer and cheaper, whilst sharp curettage has more risk of complications such as perforation and bleeding
and requires general anesthesia and a clinician. Currently, efforts are being made to increase the use of misoprostol
in the treatment of incomplete abortions in Malawi. To achieve successful implementation of misoprostol, health
care providers’ perceptions on this matter are crucial.
METHODS : A qualitative approach was used to explore health care providers’ perceptions of misoprostol for the treatment
of incomplete abortion using semi-structured in-depth interviews. Ten health care providers were interviewed
at one urban public hospital. Each interview lasted 45 min on average. Health care providers of different cadres were
interviewed in March and April 2021, nine months after taking part in a training intervention on the use of misoprostol.
Interviews were recorded, transcribed verbatim and analyzed using ‘Systematic Text Condensation’.
RESULTS : The health care providers reported many advantages with the increased use of misoprostol, such as reduced
workload, less hospitalization, fewer infections, and task-shifting. Availability of the drug and benefits for the patients
were also highlighted as important. However, some challenges were revealed, such as deciding who was eligible for
the drug and treatment failure. For these reasons, some health care providers still choose surgical treatment as their
primary method.
CONCLUSION : Findings in this study support the recommendation of increased use of misoprostol as a treatment for
incomplete abortion in Malawi, as the health care providers interviewed see many advantages with the drug. To scale
up its use, proper training and supervision are essential. A sustainable and predictable supply is needed to change
clinical practice.
