By Joyclyn Wea, gender correspondent with New Narratives

Summary:

• Liberia has ordered that misoprostol be sold only by prescription, amid concern over unregulated sales of the drug used to treat pregnancy complications and induce abortion.
• Women’s health advocates cautiously welcome the move but warn that tighter controls must not block access to care in a country with one of the world’s highest maternal mortality rates.
• A 2021 study found more than 38,000 Liberian pregnancies ended in abortion that year; more than three in five resulted in moderate or severe complications.

Liberian women’s health advocates have cautiously welcomed a government announcement that it is going to more closely regulate Misoprostol, a drug widely used to cause a medical abortion or to provide care for women facing life-threatening conditions during and after pregnancy. But they warn that the regulation must not limit access to women trying to access safe health care options.

Last week, the Ministry of Health announced that misoprostol should be sold only with a valid prescription and dispensed under the supervision of a licensed pharmacist or another authorized health worker. The ministry also says it would increase inspections, check supply chains, verify prescribers, and investigate illegal sales.

Women’s groups say the government has the right to regulate the drug. But they say the new rules must not block access to care in a country where unsafe abortion and health crises during pregnancy already cause tens of thousands of deaths and injuries each year.

“At a time when Liberia continues to grapple with high maternal mortality, public health regulations must strike a careful balance between control and access,” says Esther Eyeah David Yango, executive director of the Women NGOs Secretariat of Liberia.

The Secretariat, a national coordinating body for more than 250 women-led groups across all 15 counties, says the government should do three things as it enforces the rules: make sure women and girls are not denied care; teach the public how misoprostol should be safely used, and strengthen accountability while protecting women’s rights, privacy, and wellbeing.

The debate comes as maternal mortality and unsafe abortion remain major health problems in Liberia. Liberia has one of the world’s highest maternal mortality rates. Misoprostol can be used to help women whose pregnancies are threatening their lives and help those who are hemorrhaging after birth.

With strong limits on legal abortion, unsafe abortion also kills and maims thousands of Liberian girls and women. A 2021 national study found that more than 38,000 pregnancies ended in abortion that year. More than three in five of those abortions led to moderate or severe complications. About one in 10 ended in death or a “near miss,” meaning the woman nearly died.

The same study says 14,555 women sought care for abortion-related complications in 2021. Health advocates say the real number is likely higher because stigma and fear of legal trouble stop many women from going to a health facility. With teen pregnancy also high in Liberia, and limited sex education in schools, the burden falls heavily on girls.

FrontPage Africa interviewed women last year who had been injured during unsafe abortions. One woman said she had become pregnant at age 15 and, desperate to hide it from her parents, she sought an abortion from a man in the community who did the procedure quietly for $US50.

“The man put me on a long bed,” she recalled through tears. “Then he had plenty of iron in a pan. Then he used that; he put it inside me.”

Seven years on, T. still suffered from constant pain. Doctors told her she would not bear children. “The doctors to JFK and ELWA say the person didn’t do the work good, and the money they are requesting, my father doesn’t have that money,” she said. “I can just be praying to God, asking God to forgive me.”

Health workers say the government’s move came after growing concern about the uncontrolled sale and misuse of misoprostol. Joseph Somwarbi, a pharmacist and former chair of the House Committee on Health, says stronger control was needed because many medicine stores are not run by trained pharmacists, and many women may use the drug without proper medical advice. He said the answer should not be to block access, but to make sure the drug is used under proper medical supervision and that the public is better informed.

Misoprostol has several medical uses. It can help treat postpartum hemorrhage, manage miscarriage, and support medical abortion. Misoprostol causes cramping and bleeding to empty the uterus. The drug was first approved in the United States 25 years ago, and nearly two-thirds of abortions there are now done with medication. A medical abortion is a safe procedure that stops the growth of a pregnancy and then causes the uterus to empty.

Medical experts have also pushed back against fear about the drug itself. “The pills cannot lead to death,” Dr. Su Mon Thaw, a reproductive health professional who has worked in Liberia and abroad, told FrontPage Africa/New Narratives in an earlier interview. “There will be bleeding, which is common in medical abortion, but they don’t leave any lasting effects. Without these medications, complications of unsafe abortion can be lethal.”

That is why women’s groups say the issue is bigger than policing pharmacies. They warn that if the rules are enforced badly, poor women, girls, rural communities, adolescents, and survivors of sexual violence could be pushed toward more dangerous options.

For now, the Ministry of Health says the rules are meant to bring the drug under closer professional control. Women’s groups say they are ready to work with the ministry and other stakeholders to make sure that happens without putting more women at risk. What happens next will depend on how the new rules are enforced — and whether they improve safety without cutting women and girls off from care.

This story was produced in collaboration with New Narratives as part of the Investigating Liberia project. Funding was provided by a private donor and the Swedish International Development Cooperation Agency. The donors had no say in the story’s content.