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Keywords:

  • Misoprostol;
  • post-partum haemorrhage;
  • Millenium Development Goals;
  • essential medicine;
  • pharmaceutical;
  • off-label;
  • empirical ethics

Abstract

The debate about whether misoprostol should be distributed to low resource communities to prevent post-partum haemorrhage (PPH), recognised as a major cause of maternal mortality, is deeply polarised. This is in spite of stakeholders having access to the same evidence about the risks and benefits of misoprostol. To understand the disagreement, we conducted a qualitative analysis of the values underpinning debates surrounding community distribution of misoprostol. We found that different moral priorities, epistemic values, and attitudes towards uncertainty were the main factors sustaining the debate. With this understanding, we present a model for ethical discourse that might overcome the current impasse.