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New Drugs Underused in Averting Maternal Deaths

In 2011, 300,000 women, almost all of whom live in developing countries, died from issues related to pregnancy and childbirth. Credit: Patrick Burnett/IPS

In 2011, 300,000 women, almost all of whom live in developing countries, died from issues related to pregnancy and childbirth. Credit: Patrick Burnett/IPS

WASHINGTON, Oct 26 2012 (IPS) - In most developing countries, where a woman gives birth still determines whether she lives or dies, despite the availability of inexpensive new medication that is proven to save lives.

Most women dying from childbirth complications in developing countries do so simply because their need for medication is unknown, according to PATH, an international non-profit organisation focused on global health.

“We know maternal health medicines are safe, and we know they are effective and essential to keeping women healthy throughout pregnancy and childbirth. We also know these medicines are frequently not reaching women and community-based health facilities,” Kristy Kade, the primary author of a new PATH report, told IPS.

“What we do not know is the precise number of women for whom these essential maternal health medicines are not available – that is, women with an unmet need.”

This lack of data has led to a significant potential funding shortage. It is simply unknown how much money is being spent by affected countries and, therefore, how much more they need.

“It is very difficult to advocate for more supplies when we have almost no data on when, where, how much, how correctly, and to what standards these drugs are being used,” Kade said.

Last year, 300,000 women, almost all of whom live in developing countries, died from issues related to pregnancy and childbirth. The most common causes are postpartum haemorrhage, excessive bleeding after childbirth, and pre-eclampsia, hypertension during pregnancy.

Childbirth complications are almost nonexistent in the developed world because of effective medicines and high-quality health facilities. As these facilities are often rarely available in many developing countries, however, other medical means have been developed to address this need.

For years, Oxytocin and magnesium sulphate have been used as the primary drugs to treat complications. However, both drugs require specific storage temperatures and trained professionals to administer them, making these drugs inaccessible or even counterproductive at times.

There is also the chance that no one present at the birth will be trained in the correct way to treat the mother.

Misoprostol, a drug commonly used to treat stomach ulcers, has recently been hailed as a solution. It has the potential to reach women whose needs are currently unmet due to a lack of storage ability or trained medical professionals.

“Misoprostol is proven effective, proven safe, it is temperature stable, and no special training is required,” Adam Deixel, director of communications at Family Care International, told IPS. “This means it can be used when women birth at home or rural health facilities or where there is unreliable electricity for storing purposes.”

This drug is distributed in tablet form in the correct dosage needed if postpartum haemorrhage were to occur.

“Six million lives can be saved over the next few years with these new commodities,” Jagdish Upadhyay, with the United Nations Population Fund, told IPS. “We know the problem, we know the solution – we just need to work harder.”

Misoprostol has a fair share of complications as well, however. Although there are written instructions with the medication, it is not always in local languages and assumes the user is literate.

As with any new drug, the medical community is reluctant to see it become widespread without an appropriate level of oversight. There is also concern that women will see these pills as a lifesaving solution at home and fail seek out proper medical attention for their childbirth complications.

“The clear long-term solution is that every woman has access to the best care, well-trained medical staff and high-quality facilities,” Deixel said. “However, we cannot just write off the lives of those women because right now those facilities are just not there. This is a lifesaving option that can save lives right now.”

Misoprostol, similar to the other drugs, is easily manufactured, and developing countries, such as Ghana, have manufacturers making the drug locally. This keeps the drugs inexpensive to transport and sell.

The standards at these local manufacturers, however, often do not meet international regulation.

“Though these drugs are inexpensive, they are often sub-standard,” Kennedy Chibwe, from the U.S. Pharmacopeial Convention, told journalists in Washington earlier this week. “We need to demand quality products and keep the same standard for developed and undeveloped countries. To die from sub-standard medicine is just inexcusable.”

There is hope that these inexpensive and easily applied drugs will soon reach everyone who needs them.

“We have seen the incredible gains that can be made when there is the public support and the political will to save lives such as the millions of people receiving (drugs) as a result of HIV/AIDS activism,” Kade told IPS. “We have not seen the same amount of outrage and mobilisation for maternal mortality.”

 
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  • Judith Malik

    The two first major causes of maternal deaths in underdeveloped countries (postpartum haemorrhage and excessive bleeding after childbirth) are a direct result of poverty and hunger. Anemia, which causes these life-threatening problems is normative in pregnant women in underdeveloped countries. This has been common knowledge for decades. Rather than demand more information, more statistics, more research and more drug trials, we need to feed the starving elephant in the room. Pharmaceutical companies are attempting to market more drugs to “solve” problems which exist as a direct result global financial inequalities resulting from multinational profiteering.

  • Czikus Carriere

    Judith Malik is right. Reducing maternal death and disability is considerably more complicated than applying another pill. Above article is not very precise on the lives of which women with which complications could be saved. The impression is created as if this new medication were a panacea for most maternal death. Societal neglect and discrimination play a large role in this unconscionably high death toll. It is known that women get up first and eat last (and least) and that their specific requirements in the area of reproductive health are rarely met.

    Long before the time of giving birth to an unwanted child, women may die of haemorrhage due to a botched abortion, because contraceptives or other services were not available to prevent one more pregnancy or birth. Women may die of tetanus which two shots of tetanus toxoid during pregnancy could have prevented. They may die in the excruciating pain of obstructed labor and only a cesarean section can save their lives. They die, indeed, of postpartum haemorrhage. And if they survive the dangers of pregnancy and childbirth, they may still die of puerperal sepsis after delivery, which a course of antibiotics could cure.

    Women die of obstetric complications and in most instances Emergency Obstetric Care (like blood transfusions, c-sections, etc) is required, yet, not available, even if women manage to make it to a medical facility (with surgical services). Often, women come from far and they arrive too late at a facility that is equipped to deal with obstetric complications. Even if women survive pregnancy and childbirth they still may be damaged for life: for every woman who dies, at least 20 others suffer injuries, infection and disability.

    Czikus Carriere

  • Czikus Carriere

    Judith Malik is right. Reducing maternal death and disability is considerably more complicated than applying another pill. Above article is not very precise on the lives of which women with which complications could be saved. The impression is created as if this new medication were a panacea for most maternal death. Societal neglect and discrimination play a large role in this unconscionably high death toll. It is known that women get up first and eat last (and least) and that their specific requirements in the area of reproductive health are rarely met.

    Long before the time of giving birth to an unwanted child, women may die of haemorrhage due to a botched abortion, because contraceptives or other services were not available to prevent one more pregnancy or birth. Women may die of tetanus which two shots of tetanus toxoid during pregnancy could have prevented. They may die in the excruciating pain of obstructed labor and only a cesarean section can save their lives. They die, indeed, of postpartum haemorrhage. And if they survive the dangers of pregnancy and childbirth, they may still die of puerperal sepsis after delivery, which a course of antibiotics could cure.

    Women die of obstetric complications and in most instances Emergency Obstetric Care (like blood transfusions, c-sections, etc) is required, yet, not available, even if women manage to make it to a medical facility (with surgical services). Often, women come from far and they arrive too late at a facility that is equipped to deal with obstetric complications. Even if women survive pregnancy and childbirth they still may be damaged for life: for every woman who dies, at least 20 others suffer injuries, infection and disability.

    Czikus Carriere

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