Misoprostol for postpartum hemorrhage: Empowering health workers to save lives
by Shafia Rashid, Management Sciences for Health.
This blog was originally posted on Rights and Realities, the FCI Program of MSH.
In Senegal, approximately 1,800 women lose their lives every year while giving birth. The major cause of these deaths is uncontrolled bleeding after childbirth, or postpartum hemorrhage (PPH). More than half of Senegalese women live in rural areas and have limited access to well-equipped health facilities that can prevent or treat many of these deaths. Many women give birth, attended by matrones or volunteer birth attendants, in maternity huts. Recognized as essential health care providers by their communities, matrones have some formal training and are now registered with the Ministry of Health (MoH).
To effectively prevent or treat PPH, women need access to uterus-contracting drugs, or uterotonics, such as oxytocin or misoprostol. The recommended uterotonic, injectable oxytocin, requires cold storage and technical skill to administer. Misoprostol is a safe and effective alternative where oxytocin isn’t available or feasible; it doesn’t need refrigeration and is easy to use—particularly important features for use in remote, rural areas.
From 2013 to 2014, the Government of Senegal’s Direction of Reproductive Health and Child Survival, in partnership with USAID and Gynuity Health Projects, examined the use of misoprostol (600 mcg oral) or oxytocin (10 UI) via Uniject® for prevention of PPH at the community level. Matrones were trained to assist with deliveries and administer the designated intervention. According to the study, both misoprostol and oxytocin in Uniject® were equally effective and safe in preventing PPH, and matrones posted at the health huts were capable of administering the medicine they were assigned.
As a result of the study’s findings, the National Health Commission approved the use of misoprostol for PPH in health huts across the country and granted matrones the authority to dispense medication and attend deliveries. Prior to the release of the study findings, the Ministry of Health did not consider matrones sufficiently qualified to administer life-saving interventions. They were only authorized to intervene in cases of imminent birth; otherwise, they referred women in labor to higher levels of care.
Senegal’s recent commitment to empowering matrones and supporting community-based distribution of misoprostol for PPH prevention was codified in the National Strategic Community Health Plan (Plan National Stratégique de Santé Communautaire, 2014-2018). The government registered misoprostol for PPH prevention and treatment, making misoprostol commercially available in 2013, and included it in the update of the National Essential Medicines List in 2013.
Senegal’s National Health Plan now officially recognizes matrones as a cadre of health provider in the country’s health system and the critical role they play in providing care at the community level. Matrones and other primary level staff from all 14 regions of Senegal participated in a national training so that they can effectively contribute to the roll-out and expansion of the national program for PPH prevention. Ongoing supportive supervision and close monitoring of the program is essential to ensure that matrones have the support they need to provide essential, life-saving care to women in their communities.