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ArticleReproductive health2024

Access to mifepristone, misoprostol, and contraceptive medicines in eight countries in the Eastern Mediterranean Region: descriptive analyses of country-level assessments.

Mohamed Afifi, Nilmini Hemachandra, Qais Sikandar, Rana Hajjeh, Ulrika Rehnström Loi, Laurence Läser, Dima Qato, Zahir Sidiqui Abdul, Paata Chikvaidze, Raghad Abdul Redha Abbas and 22 more

Abstract read
In one paragraph

Article in Reproductive health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

32 authors.

Mohamed AfifiWorld Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt. afifim@who.int.ORCID http://orcid.org/0009-0003-8079-2289
Nilmini HemachandraWorld Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt.
Qais SikandarWorld Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt.
Rana HajjehWorld Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt.
Ulrika Rehnström LoiDevelopment and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Geneva, Switzerland.
Laurence LäserDevelopment and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Geneva, Switzerland.
Dima QatoDevelopment and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Geneva, Switzerland.
Zahir Sidiqui AbdulMinistry of Public Health, Kabul, Afghanistan.
Paata ChikvaidzeWorld Health Organization, Afghanistan Country Office, Kabul, Afghanistan.
Raghad Abdul Redha AbbasMinistry of Health, Baghdad, Iraq.
Khalid Al-KinaniUniversity of Baghdad, Baghdad, Iraq.
Hanan HasanWorld Health Organization, Iraq Country Office, Baghdad, Iraq.
Faysal El-KakAmerican University in Beirut, Beirut, Lebanon.
Alissar RadyLebanon Country Office, World Health Organization, Beirut, Lebanon.
Omelkheir BrngaliMinistry of Health, Tripoli, Libya.
Mohamed HashemWorld Health Organization, Libya Country Office, Tripoli, Libya.
Rachid BezadMohammed V University of Rabat, Rabat, Morocco.
Cheikh AmineCheikh Zaid Hospital, Rabat, Morocco.
Hachri HafidWorld Health Organization, Morocco Country Office, Rabat, Morocco.
Sabeen AfzalMinistry of National Health Services Regulations and Coordination, Islamabad, Pakistan.
Raza ZaidiMinistry of National Health Services Regulations and Coordination, Islamabad, Pakistan.
Ellen ThomPakistan Country Office, World Health Organization, Islamabad, Pakistan.
Qudsia UzmaPakistan Country Office, World Health Organization, Islamabad, Pakistan.
Hadeel Al-MasriPalestinian Ministry of Health, Ramallah, Palestine.
Zakri Abu QamarPalestinian Ministry of Health, Ramallah, Palestine.
Buthaina GhanemWorld Health Organization Office for West Bank and Gaza, Jerusalem, Palestine.
Itimad Abu WardWorld Health Organization Office for West Bank and Gaza, Jerusalem, Palestine.
Ali Nashat ShaarAn-Najah National University, West Bank, Palestine.
Ubah FarahMinistry of Health and Human Services, Mogadishu, Somalia.
Yusuf Omar MohamedMinistry of Health and Human Services, Mogadishu, Somalia.
Al-Umra UmarSomalia Country Office, World Health Organization, Mogadishu, Somalia.
Maha EladawyWorld Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt.

Funding

World Health Organization 001
6 · The paper itself

Abstract

backgroundDespite their importance in reducing maternal mortality, information on access to Mifepristone, Misoprostol, and contraceptive medicines in the Eastern Mediterranean Region is limited.

methodsA standardized assessment tool measuring access to Mifepristone, Misoprostol, and contraceptive medicines included in the WHO essential medicines list (EML) was implemented in eight countries in the Eastern Mediterranean Region (Afghanistan, Iraq, Lebanon, Libya, Morocco, Palestine, Pakistan, and Somalia) between 2020-2021. The assessment focused on five access measures: 1) the inclusion of medicines in national family planning guidelines; 2) inclusion of medicines in comprehensive abortion care guidelines; 3) inclusion of medicines on national essential medicines lists; 4) medicines registration; and 5) procurement and forecasting of Mifepristone, Misoprostol, and contraceptive medicines. A descriptive analysis of findings from these eight national assessments was conducted.

resultsOnly Lebanon and Pakistan included all 12 contraceptives that are enlisted in the WHO-EML within their national family planning guidelines. Only Afghanistan and Lebanon included mifepristone and mifepristone-misoprostol combination in post-abortion care guidelines, but these medicines were not included in their national EMLs. Libya and Somalia lacked a national regulatory authority for medicines registration. Most contraceptives included on the national EMLs for Lebanon, Morocco and Pakistan were registered. Misoprostol was included on the EMLs-and registered-in six countries (Afghanistan, Iraq, Lebanon, Morocco, Palestine, and Pakistan). However, only three countries procured misoprostol (Iraq, Morocco, and Somalia).

conclusionThese findings can guide efforts aimed at improving the availability of Mifepristone, Misoprostol, and contraceptive medicines in the Eastern Mediterranean Region. Opportunities include expanding national EMLs to include more options for Mifepristone, Misoprostol, and contraceptive medicines and strengthening the registration and procurement systems to ensure these medicines' availability were permitted under national law and where culturally acceptable.

Indexed as

Health Services AccessibilityMifepristoneMisoprostolAbortion, InducedContraceptive AgentsFamily Planning ServicesFemaleHumansMediterranean RegionMiddle EastPregnancyContraceptive AgentsMifepristoneMisoprostolContraceptivesEssential medicines listMifepristoneMisoprostolSexual and reproductive health

Identifiers

PMID38835050
PMCPMC11149213

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.