Bangladesh

The need:
In Bangladesh, every year more than 12,000 women die due to pregnancy or pregnancy- related causes. The estimated maternal mortality rate (MMR) is about 322 deaths per 100,000 live births.  About 29% of these deaths are due to hemorrhage.

It is estimated that more than 85% of deliveries are conducted at home, and the majority of births are attended by untrained birth attendants, relatives, or neighbors (> 80%) that are not medically trained for delivery. Most of these delivery attendants are unaware of the fatal consequences of any delay in management of obstetric emergencies especially postpartum hemorrhage.  Moreover, emergency obstetric care is neither easily available nor accessible to pregnant women in rural Bangladesh. More importantly, there is a gross misunderstanding in recognizing PPH by the mothers, birth attendants both skilled and traditional, and even obstetricians, who are relying on subjective assessment. In fact, to date there is no suitable tool available to identify a case of suspected PPH in the community, which often results in delayed referral and subsequently fatal consequences.

Goal:
To save mothers’ lives by preventing postpartum hemorrhage (PPH) at home births with misoprostol tablets for women who are unable to reach a facility to deliver. 

The Study:
The Bixby Center, working with Venture Strategies and local partners including the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) and Rangpur Dinajpur Rural Service (RDRS) Bangladesh to reach women who will deliver at home with a clean delivery kit that includes misoprostol for the prevention of postpartum hemorrhage and a blood collection mat to help women and her family members to identify when referral is needed.  The study examines the safety, feasibility and effectiveness of including misoprostol and a blood collection mat in the clean delivery kit distributed by trained traditional birth attendants to reduce deaths from post partum hemorrhage.   This study assesses the programmatic implications of scaling up misoprostol use in rural areas of Bangladesh, and will have policy implications for improving safe delivery programs in Bangladesh and other low-resource settings.

This study follows up on three previous studies in in Shreepur, Bangladesh in 2004 that trained traditional birth attendants to use misoprostol for all women delivering under their care to prevent postpartum hemorrhage.