Presentation at the Global Maternal Newborn Health Conference, October 19, 2015
Background: Maternal mortality in Ethiopia is one of the highest in the world and postpartum hemorrhage is a major cause of death. Misoprostol, an inexpensive tablet that is heat-stable and inexpensive, has proven to be very effective in preventing and treating postpartum hemorrhage; it can save lives if made accessible to women when and where they give birth, which in Ethiopia is most often at home. The MacArthur Foundation supported the Population Council to pilot a community-based approach to postpartum hemorrhage prevention in the Amhara region of Ethiopia; lay youth mentors and health extension workers were trained to bring misoprostol information and services to women in their rural communities.
Results: The project demonstrated that using trained youth lay workers to provide community-based access to misoprostol at the time of home delivery is viewed as effective and acceptable by women, community members, and many health system stakeholders. However, the evaluation identified a number of obstacles that prevented successful implementation of the model, including logistical challenges that prevented mentors and health extension workers from reaching women in labor in a timely manner, government concerns about the use of youth mentors who were not part of the health system, concerns about giving women access to the pills in advance, and fears that women would use the misoprostol to induce abortion. In addition, a strong concern that providing misoprostol at the community level would detract from the government’s efforts to encourage institutional deliveries emerged as an overarching obstacle to all efforts to achieve regional and national scale up of community-based distribution of misoprostol in Ethiopia.
Conclusion: Although the project was ultimately not successful as a model for scale up, it did contribute important information to the discussion about how to address maternal mortality in a country where most women give birth at home.