According to the latest WHO Countdown report, post-partum haemorrhage (PPH) is responsible for over a third of maternal deaths worldwide. During a session at the Global Maternal Health Conference last week, I learned about a number of prevention and treatment methods for PPH.
Dr. Sydney A. Spangler, Research Fellow at the Johns Hopkins Bloomberg School of Public Health, stressed that with any intervention, it is very important to consider the context not only on the national level, but also on the community level.
The session focused to a large extent on misoprostol, a drug that is used for treating and, importantly, preventing post-partum haemorrhage in low-resource settings with minimal financial inputs but remarkably impressive health outputs.
Notable characteristics of misoprostol:
1.) It is cheap
2.) It is widely available
3.) It has mild or no side affects
4.) It is chemically stable in high temperatures (i.e. no need to have access to refrigeration or reliable electricity supply).
Misoprostol has an interesting background story. It was initially used to treat stomach ulcers. It was then discovered to be a safe method for inducing medical abortion (i.e. with no need for surgical interventions)—and it was soon realized that the same uterine contractions that lead to abortions in the first trimester can also stop or prevent excessive bleeding during labour, making it highly effective against post-partum haemorrhage.
Blood Collection Mat
When exactly is bleeding excessive? There is always some blood loss associated with birth, and as mentioned by Shabram Shanaz from Pathfinder, women in places like Bangladesh give birth in their clothes, so it is often difficult to judge blood loss. In order to help women and their families decide when there is need to seek referral to a health clinic, an absorbent mat has been developed which indicates when a threshold of 500ml blood loss is reached. The mat is now one of the supplies given out to pregnant women.
Shabram Shanaz went on to describe how the Pathfinder project in Bangladesh taught women and their families life-saving procedures which can be implemented with or without the assistance of a skilled birth attendant. Dr. Shanaz stressed the importance of empowering women and their families. If families are provided with basic information in a clear and culturally appropriate fashion, they can quickly become skilled at labour risk management and empowered to make the right decisions–whether it be taking the appropriate medication at home or seeking hospital referral. Pathfinder not only provides educational workshops but the organization also provides women with a post-partum haemorrhage kit. The kit, packed in a bright red bag, includes everything that a woman might need–including mobile phone numbers for health workers in the area. Supplying the bags costs only US$1 per bag—but have had a huge impact on the lives of women and their families. They are empowered to act. In fact, in the Pathfinder study area, all of the women used the supply kits.
Supplying misoprostol along with other basic equipment such as blood collection mats, in a way that is easily accessible when needed (i.e. in a container which is well-labelled and difficult to lose such as the red bags handed out by Pathfinder) is a low-tech and affordable, but effective way of improving maternal health. Gaps in research and funding are not the major barriers to making preventable maternal mortality a thing of the past––we know what works and many of the effective interventions are quite affordable. Now, we need to think critically about how to get passed the barriers to implementing these proven interventions at scale.
For more posts about the Global Maternal Health Conference, click here.
Visit the conference site here.