Objective: To test the safety, acceptability, feasibility, and effectiveness of community-based education and
distribution of misoprostol for prevention of postpartum hemorrhage at home birth in Afghanistan. Methods: A
nonrandomized experimental control design in rural Afghanistan. Results: A total of 3187 women participated:
2039 in the intervention group and 1148 in the control group. Of the 1421 women in the intervention group
who took misoprostol, 100% correctly took it after birth, including 20 women with twin pregnancies. Adverse
effect rates were unexpectedly lower in the intervention group than in the comparison group. Among women
in the intervention group, 92% said they would use misoprostol in their next pregnancy. In the intervention
area where community-based distribution of misoprostol was introduced, near-universal uterotonic coverage
(92%) was achieved compared with 25% coverage in the control areas. Conclusion: In Afghanistan, communitybased
education and distribution of misoprostol is safe, acceptable, feasible, and effective. This strategy should
be considered for other countries where access to skilled attendance is limited.
© 2009 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics.