Can innovations in medicine help save rural women from haemorrhage during childbirth?

A community hospital in a Kenyan town

Last Friday the Daily Nation reported on a pilot initiative carried out by the Kenya Obstetrical and Gynaecological Society (KOGS) and Venture Strategies Innovations (VSI) to distribute a drug called misoprostol - a simple three-tablet dose to treat postpartum haemorrhage (PPH) - in rural communities in Kitui and Maragua. PPH, which is essentially excessive bleeding after delivery, is one of the leading causes of maternal death in Kenya and globally.  

The World Health Organisation’s (WHO's) recently published Priority Medicines for Mothers and Children 2011 - the first publication of its kind from the organisation - prioritises medicine for PPH and lists oxytocin as the drug of choice in this regard. However, while oxytocin injections can only be administered in a health facility, misoprostol tablets can be distributed to women for use during home births. According to the 2008/09 KDHS, only 43% of births around the country occur in a health facility. And while 75% of urban women deliver in a health facility, only 35% of rural women do so. Worryingly, these statistics have not changed significantly over the past ten years. For this reason, misoprostol has the potential to save the lives of many rural women.

The initiative’s partners argue that “the distribution of this drug at the antenatal care visits and through community midwives should be scaled up throughout Kenya” (quoted in Daily Nation, Three-tabled dose to stop bleeding and save women's lives, 31st March, 2011).  This prompts us to think about how the government can best fulfill Kenyan women’s right to health. While the right to health can be achieved ‘progressively’ depending on a country’s level of resources, there is international consensus that governments have at least some core obligations that must be achieved. These include the obligation to ensure the equitable distribution of health facilities, services and goods [i]. Misoprostol is inexpensive and easy to distribute. But it is also associated with more side effects than oxytocin. For this reason, it should not be misconstrued as an alternative for assisted delivery with a skilled birth attendant, nor should it detract efforts aimed at improving equal access to health facilities for all women across the country. Rather, efforts should be centred on identifying how it can be used in conjunction with promoting delivery at health facilities. 

 

[i] See U.N. Committee on Economic, Social and Cultural Rights, General Comment No.14, at paragraphs 43-44.