Changes in the global availability of misoprostol from 2007 to 2020

Objective To analyse global sales of misoprostol-containing products in 2016–20 in comparison to 2002–7 to identify changes in availability and access. Methods Using IQVIA MIDAS sales data, we quantified misoprostol availability across 66 countries by calculating the total weight of the active ingredient sold across three categories: misoprostol-only products, misoprostol–non-steroidal anti-inflammatory drug (NSAID) combinations, and mifepristone–misoprostol combipacks. Regional and country-level trends were assessed and compared with trends in 2002–7 data. Combipack sales data were normalized per 1000 women of reproductive age (WRA) using United Nations population estimates. Key findings Between 2002–7 and 2016–20, the availability of misoprostol–NSAID combinations declined substantially, particularly in North America, Western Europe, and Latin America. Misoprostol-only sales remained stable overall, with declines in Western Europe, North America, and Latin America offset by increases in Asia and Eastern Europe. Combipacks, absent in the earlier period, were available in 11 countries by 2020, with the highest sales in India and Bangladesh. Sales of low-strength formulations (25–100 μg), relevant for labour induction, accounted for only 5% of global misoprostol sales. Conclusion The reduced availability of misoprostol–NSAID products likely reflects declining NSAID use for arthritis management and ulcer prevention, whereas the increase in misoprostol-only sales in Asia and Eastern Europe suggests growing gynaecologic use in these regions. Continued support for the commercial viability and quality-assured supply of misoprostol is essential to ensure global access for obstetric and gynaecologic care and reduce preventable maternal mortality.