A script-writer walks into a pharmacy…

By Melissa Garcia and Elizabeth Westley

Melissa Garcia is senior technical officer and Elizabeth Westley is the director of the International Consortium for Emergency Contraception (ICEC), hosted by Management Sciences for Health.

“What happened when you went to the pharmacy and asked for emergency contraception?” Melissa surveyed a room full of television and radio writers attending a workshop in the Democratic Republic of the Congo (DRC). The participants looked around, waiting for someone to speak up first.

“The pharmacist gave me a look, so I had to show him my PMC badge to prove I was there for research, not for myself!” said a woman from Population Media Center, an organization that produces educational soap operas to improve the health and well-being of people around the world. Writers in Nigeria had similar stories to tell. An older man in flowing traditional robes confessed “I walked up and down the street three times before I summoned the courage to enter the store.” A young family planning (FP) advocate joined the media training in Senegal, and wearing her hijab, reported that the pharmacist demanded to know who the pill was meant for.

Melissa visits actors and writers on the set of C'est la vie in Senegal.
Melissa visits actors and writers on the set of C’est la vie in Senegal.

Continue reading “A script-writer walks into a pharmacy…”

Misoprostol for postpartum hemorrhage: Closing the gap between knowledge and action

By Shafia Rashid and JoAnn Paradis

Shafia Rashid is Senior Technical Advisor for the FCI Program of Management Sciences for Health and JoAnn Paradis is Strategic Communications Advisor for African Strategies for Health.

In many countries around the world, women give birth at home, often with only a family member or traditional birth attendant by their side. For these women, and for those giving birth in a health facility without reliable electricity, refrigeration, and/or IV therapy, misoprostol may be the best option for preventing and treating postpartum hemorrhage (PPH), one of the leading causes of maternal death globally.

A pregnant girl at Kigali District Hospital, Kigali, Rwanda. (Photo Credit: Todd Shapera)
Photo: Todd Shapera

Despite a global consensus on misoprostol’s safety and effectiveness for PPH prevention, few countries have closed the gap between knowledge and action–taking the steps to ensure that misoprostol is available to women where they are and when they most need it. Only a handful of countries have adopted evidence-based national policies and clinical guidelines that support the use of misoprostol for PPH, and even fewer have scaled these policies into national programs. Continue reading “Misoprostol for postpartum hemorrhage: Closing the gap between knowledge and action”

Preventing pregnancy after sexual assault: Do women and girls have access to emergency contraception?

Sarah Rich is Senior Technical Advisor at the International Consortium for Emergency Contraception, hosted by Management Sciences for Health.

Mapingure was raped and sought EC at a hospital. The provider told her that she needed a police report. But by the time she came back… she was told it was too late to assist her. She became pregnant as a result of the rape.

–Zimbabwe case from 2014, presented by Godfrey Dalitso Kangaude in “Country overviews of legal grounds/policies related to health, rape, and safe abortion,” April 2016

Emergency contraception (EC) can prevent pregnancy after unprotected sex, including in cases of rape. Global guidance on EC access for sexual assault survivors is clear: EC should be offered to women and girls within 120 hours of the assault to prevent the traumatic consequences of pregnancy resulting from rape. The World Health Organization’s (WHO) clinical and policy guidelines for sexual assault and clinical handbook  include strong recommendations to provide EC as part of comprehensive, woman-centered care. Continue reading “Preventing pregnancy after sexual assault: Do women and girls have access to emergency contraception?”

EML Search: New resource for reproductive and maternal health advocates

Shafia Rashid is Senior Technical Advisor at the FCI Program of Management Sciences for Health.

In June 2013, Imtiaz Kamal–a crusader for midwifery and women’s health–celebrated Pakistan’s official recognition of the essential maternal health medicine, misoprostol, which has proven easy to administer, safe and effective for preventing and treating excessive postpartum bleeding. “Given the high prevalence of home births,” Imtiaz explained, “we need to invest in solutions, such as misoprostol, that save lives now, until we can achieve the long-term goals of strengthening health systems and increasing rates of facility births.” Continue reading “EML Search: New resource for reproductive and maternal health advocates”

Misoprostol For Postpartum Hemorrhage – A Life-Saving Technology for Maternal Health

Shafia Rashid is Senior Technical Advisor for the FCI Program of Management Sciences for Health.

Available since the 1980s, the medicine misoprostol was initially marketed to prevent stomach ulcers. Health professionals eventually discovered that misoprostol also stimulates contractions of the uterus, making it useful for a number of maternal and reproductive health conditions, including postpartum hemorrhage (PPH), induction of labor, treatment of miscarriage, and induced abortion (alone or in combination with mifepristone). Misoprostol is stable at room temperature, available in pill form, and inexpensive. Because of these advantages and misoprostol’s wide availability in many countries, health providers began using misoprostol off-label—in a way not specified on its registration—with differing regimens and routes of administration, and in the absence of evidence-based clinical guidelines. Continue reading “Misoprostol For Postpartum Hemorrhage – A Life-Saving Technology for Maternal Health”

New research calls for a different approach for misoprostol for postpartum hemorrhage

Shafia Rashid is senior program officer for the Global Advocacy program at Family Care International.

Postpartum hemorrhage (PPH)—excessive, uncontrolled bleeding during or after childbirth—is the leading cause of maternal death around the world.  Despite this, the condition is almost entirely preventable and treatable. In some parts of the world, women give birth at home or in health facilities lacking the essential supplies and equipment to manage PPH and other life-threatening complications.

Wherever a woman decides to give birth, she needs access to life-saving, uterus-contracting drugs, called uterotonics, for the prevention and treatment of PPH. The recommended uterotonic, injectable oxytocin, requires cold storage and technical skill to administer, making it difficult or impossible to use in many rural and low-resource areas. Misoprostol is a safe and effective uterotonic and a good alternative in community settings since it doesn’t require refrigeration or administration by a professional.

miso4pack

Continue reading “New research calls for a different approach for misoprostol for postpartum hemorrhage”

Misoprostol for treatment of postpartum hemorrhage added to WHO Essential Medicines List

Shafia Rashid is senior program officer for Global Advocacy at Family Care International.

For more than five years, FCI has been working with Gynuity Health Projects and other partners to build the evidence base for expanded availability and use of misoprostol for the prevention and treatment of postpartum hemorrhage (PPH). PPH is the leading cause of maternal death, and misoprostol is a safe, effective medicine that is especially practical in low-resource settings, because it is available as a tablet and does not require refrigeration or injection.

This week marked an important milestone in global efforts to make misoprostol available to the women who need it, as the World Health Organization (WHO) approved its inclusion on the Model List of Essential Medicines (EML) for the treatment of PPH. Misoprostol was included on the EML for prevention of PPH in 2011, and the recent decision signifies WHO’s full endorsement of misoprostol as an essential maternal health medicine in settings where oxytocin — which requires cold storage and intravenous injection — is not available or cannot be used safely. The WHO Expert Committee for the Selection and Use of Essential Medicines, a panel that meets every two years to update the EML, recommended that misoprostol be listed for the additional indication of treating PPH[1] and retained on the list for prevention of PPH. Continue reading “Misoprostol for treatment of postpartum hemorrhage added to WHO Essential Medicines List”

Managing postpartum hemorrhage at home deliveries in Chitral, Pakistan

By Meagan Byrne, Program Assistant, Gynuity Health Projects

This post originally appeared on the Maternal Health Task Force blog.

In Chitral district of Khyber-Pakhtunkhwa (KP) Province, Pakistan, a high rate of home births translates to inadequate or nonexistent treatment for life-threatening obstetric complications, like postpartum hemorrhage (PPH). According to the 2012-13 Pakistan DHS report, nearly two-thirds of women deliver at home in rural areas of KP province.

Customarily, home births are managed by a traditional birth attendant (TBA) and if a complication like PPH arises, the only care available is to transfer the woman to a higher level facility or have a skilled provider called to the woman’s home to administer oxytocin as treatment. In Chitral, many villages are located far from health centers and access to care is especially difficult due to poor infrastructure and limited transport. Faced with these barriers, women who develop PPH are rarely transferred to a facility, so having treatment options available at home is critical.

Misoprostol, a prostaglandin analog that reduces blood loss after delivery, is a useful drug in this setting because it requires neither cold storage nor a skilled attendant to administer it. A recent study—implemented in Chitral by Gynuity Health Projects and Aga Khan Health Service, Pakistan—explored the feasibility of providing misoprostol to traditional birth attendants and having them administer it to prevent and treat PPH in home deliveries.

In this study, women received misoprostol prophylaxis (a 3-tablet dose) and in the event of PPH, the TBA administered a treatment dose of misoprostol with referral to a higher level of care. Study trainings reiterated the importance of transfer if a woman experiences a delivery complication. Despite prophylaxis, there were women who were diagnosed with PPH and received study treatment. The study confirmed that TBAs are able to administer misoprostol correctly and safely for both prophylaxis and treatment.

There has been an increase in the number of facility-based deliveries worldwide; yet for many women, a facility delivery is not an option. Among women in our study who had planned to have a facility delivery, many delivered at home due to road blocks, unavailable transportation, or unavailability of a family member to accompany them to the facility.

There will always be women who will not be able to deliver at a facility, despite plan to do so. Among women who deliver at home and experience PPH, many will experience delays or will never be transferred to a health facility. For these women, it is imperative to have a treatment option available at the community level since the average time from onset of PPH to death is only two hours.

The following video showcases infrastructure barriers to safe delivery and expresses the thoughts of TBAs and other healthcare providers on access to obstetric services in Chitral and the use of misoprostol to manage PPH.

 

This post is part of the blog series “Increasing access to maternal and reproductive health supplies: Leveraging lessons learned in preventing maternal mortality,” hosted by the Maternal Health Task Force, Reproductive Health Supplies Coalition/Maternal Health Supplies CaucusFamily Care International and the USAID-Accelovate program at Jhpiego which discusses the importance and methods of reaching women with lifesaving reproductive and maternal health supplies in the context of the proposed new global target of fewer than 70 maternal deaths per 100,000 births by 2030. To contribute a post, contact Katie Millar.

Let’s reward the use of maternal health supplies

By Milka Dinev, LAC Forum Regional Advisor, Reproductive Health Supplies Coalition 

This post originally appeared on the Maternal Health Task Force blog.

During a donor visit to Peru in the year 2000, a maternal health supporter and friend saw that rural women in Peru were suffering and dying because they lacked access to safe maternal health services during the critical hours of childbirth. This young donor had recently had her children, so she decided to reward the unsung heroes who made extraordinary efforts to save the lives of women during childbirth. It would be the “Oscar” of maternal health and survival.

The Sarah Faith Award was created to promote and reward the extraordinary efforts made by health providers and communities to save the lives of mothers and their children. For ten years, this award provided funding and technical assistance to the health teams and communities that had demonstrated teamwork and solidarity. Most cases were heroic efforts – transporting a mother to a rural health facility on the shoulders of four or five men using a stretcher made of wood and blankets (or in a boat along the Amazon River) or a doctor/nurse giving his or her own blood for a much-needed transfusion. The award honored deserving teams with US$25,000 to improve their health facilities or their community services. This award was an extraordinary tool to improve morale among health providers and health promoters. Each winning team received a beautiful statue that they prominently displayed in their facility.

Yet, it is worthwhile to observe that an important selection criterion for the Sarah Faith Award is how applicants improved access to maternal health services. So what happens to women who do not have access to such heroes as the ones the Sarah Faith prize rewards? I do believe this is where supplies come into play, carrying out a crucial, lifesaving role. How many lives could be saved if pregnant women had free access to misoprostol in order to prevent postpartum hemorrhage during their home delivery, or if the nurse in the health facility could administer magnesium sulfate to women with pre-eclampsia to control their blood pressure? How many lives could be saved if oxytocin supplies were adequately refrigerated?

Arguably, services — with their immediate human element — make for better story-telling a lot of the time. And good storytelling is a mainstay of the marketing and publicity that surround award mechanisms. And by comparison, supplies often carry rather sterile connotations of warehouses, supply chains, and transportation.

Working at the Reproductive Health Supplies Coalition, I am often struck by the challenge of even finding a photo that adequately tells the supplies story. And yes, there is a supplies story however, there is no “supplies award”. There is very little we do in promoting morale and engagement among those that work to make supplies available, accessible and  affordable within a framework of quality and equity!

As far as maternal health supplies go, it is easy for groups to forget the role of the three key life-saving commodities and therefore fail to prioritize their presence in health facilities 100% of the time. Much of the assistance provided through the Sarah Faith Award was directed to the direct provision of these commodities: a good fridge for the oxytocin (and vaccines of course) and a training package to update providers on the use, dosage and storage of these supplies.

The Family Planning Community has this saying “no product no program”. It is time to start using a similar phrase that includes maternal health supplies as part of a holistic approach to safe motherhood.

 

This post is part of the blog series “Increasing access to maternal and reproductive health supplies: Leveraging lessons learned in preventing maternal mortality,” hosted by the Maternal Health Task Force, Reproductive Health Supplies Coalition/Maternal Health Supplies CaucusFamily Care International and the USAID-Accelovate program at Jhpiego which discusses the importance and methods of reaching women with lifesaving reproductive and maternal health supplies in the context of the proposed new global target of fewer than 70 maternal deaths per 100,000 births by 2030. To contribute a post, contact Katie Millar.