背景:尽管它们对降低孕产妇死亡率很重要,关于获得米非司酮的信息,米索前列醇,东地中海地区的避孕药物有限。
方法:一种标准化评估工具,用于测量获得米非司酮的情况,米索前列醇,世卫组织基本药物清单(EML)中的避孕药物在东地中海区域的八个国家(阿富汗,伊拉克,黎巴嫩,利比亚,摩洛哥,巴勒斯坦,巴基斯坦,和索马里)在2020-2021年之间。评估的重点是五项获取措施:1)将药物纳入国家计划生育指南;2)将药物纳入综合堕胎护理指南;3)将药物纳入国家基本药物清单;4)药物注册;5)米非司酮的采购和预测,米索前列醇,和避孕药。对这八项国家评估的结果进行了描述性分析。
结果:只有黎巴嫩和巴基斯坦在其国家计划生育指南中纳入了WHO-EML的所有12种避孕药具。只有阿富汗和黎巴嫩在堕胎后护理指南中包括米非司酮和米非司酮-米索前列醇组合,但这些药物不包括在他们的国家EMLs。利比亚和索马里缺乏药品注册的国家监管机构。大多数避孕药包括在黎巴嫩的国家EMLs中,摩洛哥和巴基斯坦已注册。米索前列醇被列入EML,并在六个国家注册(阿富汗,伊拉克,黎巴嫩,摩洛哥,巴勒斯坦,和巴基斯坦)。然而,只有三个国家采购了米索前列醇(伊拉克,摩洛哥,和索马里)。
结论:这些发现可以指导旨在提高米非司酮可用性的努力,米索前列醇,以及东地中海地区的避孕药物。机会包括扩大国家EML,包括米非司酮的更多选择,米索前列醇,并加强注册和采购制度,以确保这些药物的可获得性是国家法律和文化上可接受的。
确保获得米非司酮,米索前列醇,避孕药物对改善妇女健康至关重要,更具体地说,降低产妇死亡率,改善东地中海区域妇女的性健康和生殖健康。这项研究的目的是分析国家评估的结果,以获取有关执行相关政策和程序的信息。这些是确保获得米非司酮的政策,米索前列醇,和研究中包括的八个东地中海区域国家在公共部门的避孕药物(阿富汗,伊拉克,利比亚,黎巴嫩,摩洛哥,巴勒斯坦,巴基斯坦,和索马里)。评估在2020年至2021年之间完成。我们发现,大多数国家并没有在其国家计划生育指南中纳入世卫组织基本药物清单(EML)中的所有12种避孕药具。没有任何国家制定了国家堕胎护理指南,也没有将米非司酮(单独或与米索前列醇联合使用)纳入国家EML。利比亚和索马里缺乏药品注册的国家监管机构。大多数避孕药包括在黎巴嫩的国家EMLs中,摩洛哥和巴基斯坦已注册。米索前列醇被列入EML-并在六个国家注册(阿富汗,伊拉克,黎巴嫩,摩洛哥,巴勒斯坦,和巴基斯坦)然而,只有三个国家采购了米索前列醇(伊拉克,摩洛哥,和索马里)。我们的发现为米非司酮的使用提供了系统级障碍的证据,米索前列醇,和避孕药(例如,缺乏关于EML的指导方针或纳入,缺乏注册和采购),可以支持加强制药部门的政策和宣传努力,以更好地确保米非司酮的供应,米索前列醇,根据国家法律和现行文化,在国家一级向育龄妇女提供避孕药具。
BACKGROUND: Despite their importance in reducing maternal mortality, information on access to Mifepristone,
Misoprostol, and contraceptive medicines in the Eastern Mediterranean Region is limited.
METHODS: A 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.
RESULTS: Only 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).
CONCLUSIONS: These 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.
Ensuring access to Mifepristone, Misoprostol, and contraceptive medicines is critical to improving women’s health, and more specifically reducing maternal mortality and improving women’s sexual and reproductive health in the Eastern Mediterranean Region.The aim of this study was to analyse findings from national assessments to capture information on the implementation of relevant policies and procedures. Those were the policies that ensure access to Mifepristone,
Misoprostol, and contraceptive medicines in the public sector for the eight Eastern Mediterranean Region countries included in the study (Afghanistan, Iraq, Libya, Lebanon, Morocco, Palestine, Pakistan, and Somalia). The assessments were completed between 2020 and 2021.We found that most countries did not include all twelve contraceptives enlisted in the WHO essential medicines list (EML) in their national family planning guidelines. No country had developed a national abortion care guidelines nor included mifepristone (alone or in combination with misoprostol) on national EML. 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) yet, only three countries procured misoprostol (Iraq, Morocco, and Somalia).Our findings provide evidence on system-level barriers to availability of Mifepristone, Misoprostol, and contraceptive medicines (e.g., lack of guidelines or inclusion on EML, lack of registration and procurement) that can support policy and advocacy efforts to strengthen the pharmaceutical sector to better ensure availability of Mifepristone, Misoprostol, and contraceptive medicines to women in reproductive age at the country-level in accordance with the national law and prevailing culture.