Esther Azasi | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: Postpartum hemorrhage is the biggest cause of maternal mortality in Ghana, responsible for approximately one quarter of maternal deaths each year. One promising approach to prevent postpartum hemorrhage is taking an inexpensive, heat-stable pill—misoprostol—just after delivery. Misoprostol can save lives if made accessible to women when and where they give birth, which in Ghana is often at home. The MacArthur Foundation supported the Earth Institute to pilot an innovative approach to community-based distribution of misoprostol through the Millennium Village Project in the Ashanti region of Ghana. The model trains community health extension workers and traditional birth attendants to reach women in their communities with information about misoprostol and encouragement to attend antenatal services. At the antenatal visit, trained midwives distribute misoprostol to women during their third trimester for use at home in the event that access to facility delivery is not possible.

Methods: A 2014 process evaluation of this work examined the successes and challenges encountered while implementing the project, the landscape of other misoprostol work in Ghana, and the current opportunities for scaling up improved access to misoprostol at the community level in Ghana.

Results: Overall, the collaborative model between skilled providers and community-based agents is proving highly effective in encouraging women to deliver at facilities with the assistance of skilled providers or have access to misoprostol for use after delivering at home, thereby preventing maternal deaths.

Conclusions: As a result of this work, Ghana is well poised to expand community-based misoprostol services to women in other rural communities where access to facility delivery is still limited, but replication and scale up is proceeding slowly. Factors impeding scale include: 1) limited resources, and 2) a prevalent concern of health providers and policy makers that the misoprostol distributed for postpartum hemorrhage prevention may be used for abortion.