As I have written many times before postpartum hemorrhage (PPH) or excessive uterine bleeding after childbirth is the leading cause of maternal mortality in low-and-middle income countries. The recommended drug to prevent PPH according to the World Health Organization (WHO) is oxytocin. When administered in its recommended dose it causes little to no side effects. Oxytocin, the WHO’s current gold standard therapy, however, must be refrigerated and administered by skilled health workers posing two obstacles to its wider use in low resource, tropical settings.
Some countries have approved misoprostol, an oral drug, to prevent PPH, but there are several concerns that its use can be misappropriated for abortions instead of used solely for PPH. The World Health Organization has listed misoprostol as an alternative to oxytocin if it is not available.
Now, another PPH preventative drug, carbetocin, has been added to the latest updated 2019 WHO Essential Medicines List. The announcement was made last week. Unlike oxytocin, even at high temperatures carbetocin remains effective. The recommendation is that carbetocin can be used when oxytocin is not available or if its quality is uncertain. Additionally, the cost must be comparable to oxytocin.
Maternal mortality continues to be a major problem the world over. The United States is the only developed country where maternal death rates are increasing especially for non-Hispanic black women. And in low-and-middle income countries, approximately 830 women die each day from pregnancy-related, preventable causes.
Maternal health organizations are working diligently to save more mothers’ lives, but one death is still too many especially when it is likely preventable. I like to list organizations that you can support with donations in order to help them keep more women and their children alive on the local level and make sure mothers are a part of their families’ lives.
This list highlights local organizations that help some of the most vulnerable communities in countries with some of the highest maternal mortality rates. And, in the cases of the United States and Australia, the organizations help the communities that experience the most maternal deaths. Each site allows direct donations that go directly to maternal care and/or advocacy.
The Kenyan Medical Practitioners and Dentists Board has stopped the NGO Marie Stopes International from performing abortions in Kenya. Marie Stopes is a global organisation that provides contraception and safe abortion to women in urban and rural communities. Abortion is illegal in Kenya, unless a trained medical professional judges that there’s a need for emergency treatment, or that a woman’s life or health is in danger.
The Conversation Africa’s Moina Spooner spoke to Michael Mutua about the Marie Stopes ban and its implications.
How did the ban come about?
According to the Kenya Medical Practitioners and Dentists Board, they banned abortion services provided by Marie Stopes following complaints from the general public. The public claimed the organisation was running pro-choice media campaigns. These adverts specifically sought to provide women with a solution when faced with crisis pregnancies.
The adverts were also criticised by the Kenya Film Classification Board, which ordered Marie Stopes to pull them down for allegedly promoting abortion.
The relatively large number of American women who die due to childbirth is one of the little-known facts in our country. In a nation where we spend exorbitant amounts on healthcare, we have the highest maternal mortality rate of any other developed country. Word, however, is getting out that women are increasingly susceptible of dying during childbirth with a surge in articles in major publications and of hospitals, healthcare workers, and researchers working together to solve this problem.
We know that women in low-and-middle income countries are especially prone to maternal mortality. Those of us of who write about maternal health and keep up with worldwide maternal health, mortality, and morbidity statistics understand that in the world’s poorest countries we find the worst outcomes for both mothers and their infants. In recent years, we have also discovered that maternal health rates in the United States are far higher than acceptable. In fact, the United States has the highest maternal mortality rate than any other developed country in the world. The countries that have the lowest maternal mortality rates are European. But that can be misleading as well.
Safe Motherhood Week , that is recognized each year between October 2 – 8, is the first coalition of partners of its kind to focus on maternal health in Europe. Some statistics will surprise you. Did you know five European women die every day from maternal health complications and in 2013, 1900 European women died from maternal health complications. Additionally, 1 in 10 women in Europe does not have access to maternal health care in the first few months of their pregnancies.
As a mother of two, I did not have optimal experiences either time I was pregnant. Each of my pregnancies was different, but the feeling I had with both of them was identical. I never felt like my physicians really cared about my pregnancies or deliveries, but that I was just a number to them. I have always chalked it up to being relatively young. I was in my mid-twenties. Even still, I believe to this day that I should have been treated with more dignity and respect. Even in two different states, I was treated the same way – with relative indifference. Even though my oldest daughter is 19, I’m still bitter about it.