In many low-resource settings, local governments are striving to build a qualified workforce of skilled providers to increase maternal survival. Despite impressive gains in providing access to skilled care at birth, which includes active management of the third stage of labor to prevent postpartum hemorrhage (PPH), these efforts have often not kept pace with the need to provide universalaccess to care. Vast numbers of women in remote areas continue to deliver without the assistance of a skilled provider. In 2001, Jhpiego developed an innovative, community-based strategy to prevent bleeding after birth and save the lives of women who deliver at home without skilled care.
Under the technical vanguard of Dr. Harshad Sanghvi, Jhpiego collaborated with the Ministry of Health in Indonesia to pilot the distribution of misoprostol (a drug that helps the uterus contract, or uterotonic) at the community level to prevent postpartum hemorrhage at home births. Trained community health workers visited households to provide education to pregnant women and their support persons on birth preparedness, complication readiness and the importance of delivering with a skilled provider. In addition, the community health workers educated women about how to self-administer oral misoprostol correctly, in the event that they delivered at home.
In the wake of this successful demonstration project, pilot programs in Indonesia and Afghanistan followed, giving further evidence of the safety, acceptability, feasibility and program effectiveness of the intervention. Jhpiego has provided technical assistance to governments and partners in nine countries in the use of community-based distribution of misoprostol, including scale-up within government health services in Nepal and Afghanistan.
Using a comprehensive approach to the prevention PPH along the continuum of care that involves strengthening prevention and management of PPH at the facility level, and community-based distribution of misoprostol for home births, both programs successfully raised uterotonic coverage. In Nepal, uterotonic coverage increased remarkably from 11.6 percent to 74.2 percent, with the most substantial increases among the most vulnerable—the poor, illiterate and those living in remote locations.This simple and inexpensive intervention has made a positive impact in the prevention of PPH regardless of where the pregnant woman gives birth.