Doris began having contractions at home in her village in rural Zambia. Accompanied by a village health worker, she began the trek to the nearby clinic, miles down a dusty road. As a mother of four, Doris knows first-hand the dangers of pregnancy and childbirth and while at a prenatal clinic visit, received three misoprostol tablets. En route, still a long distance from the clinic, the contractions became too great and Doris labored through childbirth on the side of the road. With the support of the trained health worker and three misoprostol tablets, Doris safely delivered her baby girl Mary.
Postpartum hemorrhage (PPH), or excessive bleeding after childbirth, is the leading cause of maternal death globally. Of the over 287,000 maternal deaths annually, approximately a quarter are due to PPH, and in sub-Saharan Africa the figure is over a third (Khan, 2006). That is a staggering 70,000 mothers who literally bleed to death in childbirth. And yet, simple and effective prevention and treatment methods exist.
VSI is leading efforts to ensure that misoprostol tablets are available to the thousands of women who cannot reach a health facility to deliver, or who give birth in ill-equipped and understaffed facilities that render conventional methods of preventing and treating blood loss infeasible.
In VSI’s most successful program, VSI works with partners to create access to misoprostol to contribute to achieving safe motherhood goals in developing countries. To date, with VSI leadership, 17 countries have registered misoprostol for PPH, 10 countries have included misoprostol on national essential medicines list and standard treatment guidelines, and 11 operations research programs have demonstrated innovative models for reaching expectant mothers with misoprostol.
Building on introduction activities in Tanzania, VSI comprehensively accessed the gaps and opportunities to ensuring everyday availability of misoprostol for PPH in the country’s health system. The framework, methodology and tools created during this assessment served to develop recommendations for partners and the Ministry of Health and Social Welfare to draw upon in efforts improve product availability over time.