MCHIP Director Koki Agarwal blogs on a potentially livesaving drug
Bleeding to death after delivery is the leading cause of maternal death worldwide, with the greatest burden of disease in the developing world. Women who give birth at home are especially vulnerable to succumb to this largely preventable cause of death. To address this, the MCHIP Project, which is USAID’s flagship maternal and child health program, is training community health workers to educate women in their homes-and arming them with just three tablets of misoprostol, a potentially lifesaving drug.
Easy to administer, misoprostol is an oral uterotonic in tablet form that does not require refrigeration or storage in a cool, dark place, or administration by a skilled attendant. Because women can die within two hours of the onset of bleeding with postpartum hemorrhage (PPH), a key prevention strategy must include advance provision of misoprostol to expectant mothers for self-administration after birth.
MCHIP projects in a number of countries have demonstrated that antenatal care providers and health workers in the community can effectively distribute-and women can safely use-misoprostol for PPH prevention during home birth. In Tanzania, for example, women who delivered at home and did not use misoprostol were almost nine times more likely to need additional interventions for the treatment for PPH than those who used the drug . Moreover, distribution of the drug directly to women has proved to increase the proportion of women who are covered by use of a uterotonic drug immediately after birth. Providing them with the three tablets of misoprostol has also not prevented communities from seeking delivery care at a facility. In fact, in almost all MCHIP programs, as a consequence of effective counseling, more women have delivered with a skilled attendant.
This International Women’s Day, let’s continue our work to help women help themselves. Rarely the decision-makers in their households, women in low-resource settings-where the majority of these deaths occur-are often assumed to be incapable of correctly taking misoprostol . An expectant mother is the only person who will surely be there at the time of her delivery. Who better, then, to receive misoprostol and be trained to take it responsibly?
In the public health community, we know well the close link between a mother’s health and that of her children-if a mother passes away in childbirth, there is a more than 75% chance that her baby will not survive. Therefore, whatever we can do to ensure that when women deliver at home, they have access to misoprostol and related training, the less we have to worry about finding someone to help her should a life-threatening hemorrhage occur. And the more confident we can feel in her continued health, the more confidence we can have in the security of her family and the health of her larger community.
Ideally, all women would have access to a skilled attendant for their birth, and the necessary emergency obstetric care to handle life-threatening emergencies. As we work toward that goal, putting misoprostol in the hands of all women who may need it is the best way forward.
Happy International Women’s Day!
Koki Agarwal is the director of the Maternal and Child Health Integrated Program(MCHIP).
Ifakara Health Institute, Venture Strategies Innovations, et al. 2011. Prevention of Postpartum Hemorrhage in Home Births:Misoprostol Distribution during Antenatal Care Visits in Tanzania. Final Report Brief. (February)