Lessons learned from a community-based distribution of misoprostol to prevent postpartum hemorrhage in rural Ghana: Recommendations for global maternal health policy and practice

A number of innovative strategies have sought to impact the 2015 Millennium Development Goals, specifically the 75% reduction in maternal deaths. Despite global decreases in maternal mortality, postpartum hemorrhage continues to be a leading cause of death in developing countries, and many countries will not meet maternal-related Millennium Development Goals by 2015.

While we recognize the importance of promoting skilled attendance at all births, we acknowledge that some women will continue to deliver at home in low-resource settings due to various constraints.  Countries with high home birth rates should consider antenatal community-based distribution of misoprostol, a drug proven to be effective for the prevention of postpartum hemorrhage.

We present the findings from a recent operations research study conducted in rural Ghana in which we assessed the safety, feasibility, and acceptability of community-based distribution of misoprostol to prevent PPH at home deliveries.

The study had five components; 1) training of primary healthcare workers, 2) providing misoprostol to community-based midwives for antenatal distribution, 3) conducting a rigorous evaluation of the distribution model, 4) providing technical assistance to the Ghana Health Service for state-led sustainability and scale up, and 5) disseminating findings to inform policy across the global community. We have identified the advantages, barriers, and recommendations of using a community-based distribution model of misoprostol. 

We successfully tracked over 98% of the 999 doses distributed to midwives at health facilities. Of the women who had misoprostol for home birth, 81% had an institutional delivery and returned the misoprostol safely to the midwife. Of the 93 women that used misoprostol, 99% used misoprostol correctly.

We demonstrated that community-based distribution of misoprostol to pregnant women is safe, feasible, and acceptable for prevention of postpartum hemorrhage.  This model is translatable and sustainable; health systems can successfully implement community-based programs to reduce postpartum hemorrhage-related morbidity and mortality.