Saybi Saple, a resident of a remote village in central India, is one of around 2.4 million women who delivered her baby at home last year in the country. A Unitaid-funded project is working to ensure that all births, including home births, are safe, and to prevent women from excessive bleeding after birth—a leading cause of maternal death that claims around 7,200 precious lives in India and 85,000 globally.
Saybi is one of the women who benefited from this project. This is her story.
Saybi got pregnant for the third time when she and her husband were away from home on a work assignment. They are daily wage laborers and often need to travel to neighboring villages to find work, relying on physical labor to support their family of six—two sons and Dadiram’s parents. Six months into her pregnancy, when the couple returned home, Saybi was exceptionally pale and experiencing fatigue and headaches.
The 25-year-old mother recalls how she found it hard to manage the walk along the mud path that summer, followed by a three-kilometer uphill climb to reach her remote village. There was no public transport around their remote hut. She was used to the walk, but this pregnancy was taking a bigger toll on her than the earlier two.
Luckily, soon after Saybi’s return, help arrived at her doorstep. She received a visit from Sangeeta Dawar, a type of community health worker (CHW) referred to as an accredited social health activist (ASHA), and Akki Chauhan, a Field Officer with a community-based organization (CBO) called Pahal Jan Sahyog Vikas Sansthan. When Sangeeta and Akki met Saybi during their village rounds, they immediately registered the pregnancy and ensured that she attended a Village Health Sanitation and Nutrition Day at the neighboring child health center. At this event, auxiliary nurse midwife (ANM) Jaywanti Parate checked Saybi’s weight and blood pressure and conducted the necessary blood and urine tests. When Saybi’s tests revealed that she was highly anemic, Jaywanti gave her the required supplements, including iron and calcium. She emphasized the importance of a nutritious diet and asked Saybi to come back for regular follow-up visits.
Sangeeta and Akki knew that they needed to pay special attention to Saybi. Both of them, as well as Jaywanti, had received comprehensive training under the Unitaid-funded project called Accelerating Measurable Progress and Leveraging Investments for Postpartum Hemorrhage Impact (AMPLI-PPHI). The main goal of AMPLI-PPHI is to save women’s lives by preventing severe bleeding after childbirth, also known as postpartum hemorrhage (PPH). The project has aligned its PPH prevention and management strategies with the World Health Organization’s recommendation that every woman receive a uterotonic medicine to prevent PPH.
Saikiran Sambhaji Khandre, Program Officer of the AMPLI-PPHI project in Khargone District, explains the role of CHWs: “Their role is vital at the village level. Right from the time a pregnancy is registered, the ASHA, ANM and CBO partner use certain screening criteria to assess whether the pregnant woman would be likely to deliver at a health care facility or home—criteria include questions like whether any of the earlier deliveries have happened at home, does she live in a very remote area with poor accessibility, whether she has small children at home and no one to take care of them in her absence, etc. The CHWs continually encourage the women to deliver at a health facility. But if they sense that even after completing 35 weeks of pregnancy (end of eight months), a woman has a chance of home delivery, the ASHA visits the woman in her home and provides her with medicine [to prevent PPH].”
The process described by Saikiran is in keeping with the project’s objective to get lifesaving drugs into the hands of pregnant women who need them the most, women like Saybi. The facts that Saybi’s second child was delivered at home and that she lives far from to the nearest health facility made her an ideal candidate to receive PPH prevention medicine.
In India, the AMPLI-PPHI project is working across 84 health facilities and their neighboring communities in the states of Maharashtra and Madhya Pradesh. The project has trained approximately 900 health facility staff in PPH management and around 200 CHWs in advance distribution of PPH prevention medicine for self administration.
We provide thorough training to the CHWs and provide ASHAs with communication tools like flip-books and posters to assist them in accurate messaging. When the ASHA hands over the PPH prevention medicine to the woman in her home, she ensures that it is the entire family that learns its use and takes responsibility to keep it in an accessible, clean place. The ASHA instructs the woman to consume 600 micrograms or three tablets as soon as the baby is delivered, within a minute.”
Saikiran Sambhaji Khandre
Saybi and her mother-in-law remembered the instructions well and ensured that she took those three important tablets as soon as the baby was born. Saybi did not get PPH, and today, she and her four-month old baby, Neeraj, are both doing well.
As she sits at the door of her hut playing with Neeraj and his two brothers, Saybi thanks the CHWs who helped her through this last pregnancy. “I am so grateful to Akki and Sangeeta Didi [sister] for their help,” says the mother, with a happy smile. “Without them, I wouldn’t have known what to do during my delivery. The tablets they gave me saved my life and my baby’s life. I wish all women in our village could get this kind of care.”
About AMPLI-PPHI
The Unitaid-funded Accelerating Measurable Progress and Leveraging Investments for Postpartum Hemorrhage Impact (AMPLI-PPHI) project (2022–2026) is a $24 million initiative that focuses on generating evidence and learning, creating an enabling environment, and preparing the market to enable broad uptake of three postpartum hemorrhage prevention drugs in low- and middle-income countries. The Unitaid-Jhpiego program is working in partnership with the International Federation of Gynecology and Obstetrics (FIGO), PATH and country governments in the Democratic Republic of Congo, Guinea, India and Kenya to ensure PPH medications are available at the right time, in the right place, for the right indication and for the right patient across health systems. With complementary funding from Safe Birth Africa, a joint Unitaid-UNFPA venture backed by the European Union, AMPLI-PPHI expanded to Nigeria and Zambia in 2024 to bring greater access to pregnant women and stop bleeding after birth, ultimately reducing maternal morbidity and mortality.
Contributions: Dr. Chirag Bhola, Nabanita Das and Indrani Kashyap