More than half of all women around the world give birth at home. That means that out of approximately 135 million births in 2011, 68 million occurred at home, likely without a skilled birth attendant.
The World Health Organization (WHO) recommends that to prevent postpartum hemorrhage—the leading cause of maternal death—all women receive oxytocin or misoprostol during the third stage of labor. Although oxytocin is the drug of choice for prevention and treatment of postpartum hemorrhage, it also requires complementary supplies, namely an IV, and a skilled birth attendant.
In low-resource setting where skilled birth attendants, oxytocin and/or the complementary supplies are not available, global recommendations clearly state that misoprostol should be administered by community health care workers or lay health workers to prevent postpartum hemorrhage. But despite WHO recommendations and the clear need for greater access to maternal health supplies around the world, many countries have not yet incorporated misoprostol in safe motherhood programs.
Including misoprostol for postpartum hemorrhage on a country’s national Essential Medicine List (EML) is one of the first steps to ensuring that the drug is actually registered and then purchased. In a review of available national Essential Medicine Lists, 31 out of 59 developed countries reviewed did not have misoprostol on the national EML. This despite the fact that misoprostol appears on the core list of WHO’s Model List of Essential Medicines—the list of minimum medicine needs for a basic health care system. Why is it such a struggle to ensure that misoprostol is available at the country level?
Some of the challenge lies in the fact that misoprostol has many uses—including for abortion. Obstetric and gynecological uses of misoprostol include: preventing postpartum hemorrhage (where oxytocin is not available or cannot be safely used); inducing labor; managing incomplete abortion; and inducing abortion. The potential for misoprostol to induce abortion should not outweigh its potential life-saving abilities.
Postpartum hemorrhage is unpredictable, and millions of women risk bleeding to death every year due to childbirth. Countries cannot continue to ignore the needs of women when there is an effective, low-cost preventive option. We need to work to make sure misoprostol is included in safe motherhood programs, and quality products are available through well-trained community and lay health workers.
Every woman deserves to survive childbirth, regardless of whether she delivers outside a health facility, or without a skilled birth attendant.