In a simple concrete room in Namacurra, the VSI trainer pauses as the participants—traditional birth attendants—spontaneously break into song. These lay health workers are learning how to provide pregnant mothers in their communities with misoprostol tablets to prevent life-threatening bleeding in childbirth. The TBAs have no formal education and in response VSI adapted our training materials to be picture-based and conducted in the local language. But these women preferred to retain their lessons in verse. In a sing-song tandem, the trainer shared the facts, while a room full of women repeated back in chorus.
VSI believes that we have to reach pregnant mothers not just where we want them to be, which is delivering in a facility, but where they are now. In Mozambique, most mothers deliver their babies at home. These women are at the greatest risk of dying in childbirth—and all too often from excessive bleeding after childbirth, or postpartum hemorrhage. We aim to change that.
VSI trained the providers closest to women, like the rural TBAs in Nacala and the registered TBAs in Namacurra that provide a direct link from the village to the rural health center. VSI is working in partnership with the Ministry of Health, the Mozambican Obstetricians and Gynecologists Association (AMOG), PSI, pharmaceutical distributors and other nongovernmental organizations to increase access to and knowledge of misoprostol for use in preventing postpartum hemorrhage. The results of this project are here. In Mozambique, we also introduced misoprostol for treatment of complications of abortion and miscarriage, which can occur naturally or due to the far too common practice of unsafe abortion. The results of this project are here.
- Training health care providers including doctors, midwives, and nurses on how to use misoprostol to prevent and treat PPH and manage complications of abortion; and educating TBAs on prevention of PPH
- Gaining government commitment by developing policies to ensure that women have access to misoprostol now and in the future. Mozambique took a significant first step with the successful registration of misoprostol for gynecological and obstetric use in 2009 and subsequently included misoprostol in the Clinical Guidelines for Postpartum and Delivery Care released in 2012.
- Breaking down barriers to access by training drug distributors and assisting them in reaching community-level health care workers and women; the life-saving drug is currently being sold in both the public and private sectors.
- Identifying and addressing gaps in essential services for postabortion care (PAC), by training nurses and midwives on misoprostol for PAC.
Relevant Media Coverage:
National Public Radio, June 29, 2011, "Drug given to mothers at birth sparks controversy" (United States)
By the Numbers
Estimated Total Population
Lifetime Risk of Maternal Death
1 woman in 37
Maternal Mortality Ratio
550 per 100,000 live-births
Total Fertility Rate
Births Attended by Skilled Health Provider
Unmet Need for Family Planning
Source: PRB, 2011 and WHO, 2010
Registered Misoprostol Product(s): Misotac®; Isovent®