title: New hope: community-based misoprostol use to prevent postpartum haemorrhage.
abstract: The wide gap in maternal mortality ratios worldwide indicates major inequities in the levels of risk women face during pregnancy. Two priority strategies have emerged among safe motherhood advocates: increasing the quality of emergency obstetric care facilities and deploying skilled birth attendants. The training of traditional birth attendants, a strategy employed in the 1970s and 1980s, is no longer considered a best practice. However, inadequate access to emergency obstetric care and skilled birth attendants means women living in remote areas continue to die in large numbers from preventable maternal causes. This paper outlines an intervention to address the leading direct cause of maternal mortality, postpartum haemorrhage. The potential for saving maternal lives might increase if community-based birth attendants, women themselves, or other community members could be trained to use misoprostol to prevent postpartum haemorrhage. The growing body of evidence regarding the safety and efficacy of misoprostol for this indication raises the question: if achievement of the fifth Millennium Development Goal is truly a priority, why can policy makers and women's health advocates not see that misoprostol distribution at the community level might have life-saving benefits that outweigh risks?
authors.affiliation: Bixby Center for Population, Health and Sustainability, University of California at Berkeley, CA 94720, USA. ndola@berkeley.edu
authors.forename: Ndola
authors.initials: N
authors.lastname: Prata
authors.forename: Paige
authors.initials: P
authors.lastname: Passano
authors.forename: Suzanne
authors.initials: S
authors.lastname: Bell
authors.forename: Tami
authors.initials: T
authors.lastname: Rowen
authors.forename: Malcolm
authors.initials: M
authors.lastname: Potts
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000191:economics / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008427:Maternal Health Services; D008428:Maternal Mortality / Q000639:trends; D008880:Midwifery / Q000193:education; D016595:Misoprostol / Q000191:economics / Q000627:therapeutic use*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol