Sri Lanka: misoprostol v unsafe abortion

Many thanks to Ramya Kumar, a doctoral student at the University of Toronto’s Dalla Lana School of Public Health, for submitting this abstract of her M.Sc. thesis in Public Health from Harvard University.  The author can be reached at:


by Ramya Kumar M.Sc. thesis, Harvard University, 2011.

Abstract:  Addressing unsafe abortion has been a contentious issue globally. Sri Lanka has made impressive achievements on the 5th Millennium Development Goal (Improving Maternal Health) with a maternal mortality rate of 39 deaths per 100,000 live births. But unsafe abortion remains unaddressed even when it is a leading cause of maternal mortality in the country. Abortion laws are restrictive and safe abortion services are not provided through the public health system. Misoprostol, a drug with many obstetric uses (including medical abortion) is as yet unregistered. A recent attempt to register misoprostol ended controversially when registration was stalled at the National Drug Regulatory Authority despite a recommendation to register the drug from the professional body of obstetricians and gynaecologists in the country. This study attempts to identify policy-level barriers to addressing unsafe abortion in Sri Lanka broadly and considers the recent policy decision on misoprostol specifically.      Fourteen key informants were interviewed; 10 physicians involved in health policymaking and 4 women’s rights advocates with expertise in law and the social sciences. Data was analyzed using qualitative methods.
The results suggest that the Ministry of Health in Sri Lanka has failed to prioritize addressing unsafe abortion even within the existing legal framework. The barriers identified appear to be similar to those operating at a global level. The resistance to abortion law reform, the position of the medical establishment vis-à-vis misoprostol and the absence of endorsement by the Ministry of Health to addressing the issue of unsafe abortion appear to be supported by patriarchy, religious conservatism and nationalism. The inaccessibility of safe abortion services has grave implications on women’s health and rights. The policy decision on misoprostol exemplifies an undemocratic policymaking process; a rights-based approach is explored as a potential solution to addressing unsafe abortion.

For further information on “Misoprostol and Women’s Health in Sri Lanka,” see this newspaper article by Ramya Kumar, based on her presentation at the International Centre for Ethnic Studies, Colombo, Sri Lanka, on July 13, 2011: Online here

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