Abortion induced by physical trauma has a long history. This article describes bas-relief sculptures in Angkor Wat, Cambodia dating from the 9th to the 12th centuries, and compares them to contemporary observations of massage abortion. The Cambodian carvings, along with two similar representations in Indonesia, are the earliest known illustrations of an abortion in progress. The bas-reliefs prove that abortion techniques were well understood at the time, although their cultural interpretation is uncerain.
Published in Journal of Family Planning and Reproductive Health Care,...
The objective of this book is to bring together within a single volume the most up to date information about the epidemiology, diagnosis and management of postpartum hemmorrhage. Whilst much has been published on the subject a truly comprehensive synthesis of this kind has never before been attempted. This volume sets out, therefore, to provide physicians with an overall clinical perspective that has hitherto been unavailable.
Published in A Textbook of Postpartum Hemorrhage, Sapiens Publishing, October 2006, 18,4-190...
Chapter 16 in A Textbook of Postpartum Hemorrhage discussing Misoprostol in Practice
“As a low-cost, easy-to-administer, powerful uterotonic with an excellent safety profile and long shelf-life, misoprostol has a revolutionary potential to reduce death and morbidity from postpartum hemorrhage in precisely those situations where it is most common – delivery at home without a skilled birth attendant.”
Published in A Textbook of Postpartum Hemorrhage, Sapiens Publishing, October 2006, 178-179
Chapter 17 in A Textbook of Postpartum Hemorrhage discussing Management of Postpartum Hemorrhage at the Community Level
The objective of this book is to bring together within a single volume the most up to date information about the epidemiology, diagnosis and management of postpartum hemorrhage. Whilst much has been published on the subject a truly comprehensive synthesis of this kind has never before been attempted. This volume sets out, therefore, to provide physicians with an overall clinical perspective that has hitherto been unavailable.
Literature review to identify interventions that require minimal treatment/infrastructure and are not dependent on skilled providers. Simulations were run to assess the potential number of maternal lives that could be saved through intervention implementation according to potential program impact. Regional and country level estimates are provided as examples of settings that would most benefit from proposed interventions.
Three interventions were identified: (i) improve access to contraception; (ii) increase efforts to reduce deaths from unsafe abortion; and (iii) increase access to...
The current paper examines the realities of women delivering in resource-poor settings, and recommends cost-effective, scalable strategies for making these deliveries safer. Ninety-five percent of maternal deaths occur in poor settings, and the largest proportion of these deaths are women who deliver at home, far away from health care facilities, and without financial access to skilled providers. This situation will improve only when policymakers and programme planners refocus their attention on service delivery and financing interventions, with the potential to reach the largest portion...
The silence about population growth in recent decades has hindered the ability of those concerned with ecological change, resource scarcity, health and educational systems, national security, and other global challenges to look with maximum objectivity at the problems they confront. Two central questions about population—(i) is population growth a problem? and (2) what causes fertility decline?—are often intertwined; if people think the second question implies possible coercion, or fear of upsetting cultures, they can be reluctant to talk about the first. The classic and economic theories...
Misoprostol is a safe, acceptable, feasible, and effective alternative for both postpartum hemorrhage (PPH) and the treatment of incomplete abortion and miscarriage when no other interventions are available, which is often the case in resource-challenged regions. This article reviews the use of misoprostol for these two leading causes of maternal death globally and presents data on the implementation of misoprostol for PPH in Zanzibar as a case study. An evaluation was conducted to assess the uptake of misoprostol in public facilities in Zanzibar through a record review at nine facilities...
This comment in the explores the role of policy and research in using the prevention of postpartum hemorrhage and suggest a joint meeting by WHO and FIGO to revisit the 2009 statement by WHO which does not recommend the use of misoprostol at the community level.
Objective: Guide policy-makers in prioritizing safe motherhood interventions.
Methods: Three models (LOW, MED, HIGH) were constructed based on 34 sub-Saharan African countries to assess the relative cost-effectiveness of available safe motherhood interventions. Cost and effectiveness data were compiled and inserted into the WHO Mother Baby Package Costing Spreadsheet. For each model we assessed the percentage in maternal mortality reduction after implementing all interventions, and optimal combinations of interventions given restricted budgets of US$ 0.50, US$ 1.00, US$ 1.50 per...
