For Hauwa childbirth used to be a frightful experience - the stuff of nightmares. Having already delivered seven babies, excessive bleeding after childbirth was an all too common reality. Thankfully, she had not shared the fate of other mothers in her community who tragically died while giving life. But the fear was there and kept her awake at night throughout her pregnancy. Delivering at home, she always hoped for the bleeding to stop on its own because she had no drugs to treat it. Hope is not medicine. It was during the birth of her recent child that a traditional birth attendant gave her misoprostol tablets after delivery. The worrisome bleeding did not come. Her child, Abdulaay, is one of the “miso boys” in the community of Hayin Ojo, children born to mothers who no longer risk bleeding to death in their homes, far away from health services and efficient transportation.
In 2006, Nigeria became the first country in the world to approve the use of generic misoprostol tablets for control of postpartum hemorrhage; and in 2011, misoprostol was approved for use in postabortion care (PAC). VSI worked with local partners to increase women’s access to these life-saving tablets.
At the close of our program in 2010, Nigeria had achieved the following milestones:
- Trained over 2,500 health care providers including doctors, midwives, nurses, pharmacists and traditional birth attendants on the effective use of misoprostol for prevention and treatment of PPH.
- Jointly completed groundbreaking operations research in Northern Nigeria that provided empirical evidence on community-based distribution of misoprostol for prevention of PPH and culminated in nationally approved guidelines for the use of misoprostol at the community level. The results of this project are here.
- Encouraged price competition by supporting registration of multiple misoprostol products in the country, including the socially marketed product, Mistol®, by Society for Family Health, and an additional product, Misoclear®, for PAC.
- Supported policy developments to ensure mothers’ access to misoprostol, including its addition to the national clinical guidelines and 2010 essential medicines list.
“Given the prevailing concern and commitment of the President Goodluck Jonathan Administration towards the reduction of high maternal mortality ratio in the country, Misoprostol, which has been found useful in the control of post-partum haemorrhage, has for the first time been included on the [essential medicines] list. In view of this, it is assured that this edition is enriched and has advantage over previous ones.”
-Minister of Health, Professor C. O. Onyebuchi Chukwu
5th Ed.National Essential Medicines Lists, Federal Republic of Nigeria (2010)
VSI’s program succesfully demonstrated that misoprostol is safe and effective in the communities where it is needed most, acceptable to women and providers alike, and an essential drug to help bring about a reduction in Nigeria’s high maternal mortality. The country is poised to scale-up this life-saving intervention and VSI invites collaborative efforts to ensure ready access for all Nigerian women in need.
Hausa women in a VSI program area in Northern Nigeria sing the praises of "miso" - the misoprostol tablets that make childbirth safer for women in their communities.
Photo Credit: ©2009 E Nesper - VSI
By the Numbers
Estimated Total Population
Lifetime Risk of Maternal Death
1 woman in 23
Maternal Mortality Ratio
840 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): Misoprostol®, Mistol®, Misoclear®