title: Helping rural women in Pakistan to prevent postpartum hemorrhage: a quasi experimental study.
abstract: BACKGROUND
  According to the Pakistan Demographic and Health Survey from 2006-2007, the maternal mortality ratio in rural areas is 319 per 100,000 live births. Postpartum hemorrhage is the leading cause of maternal deaths in Pakistan. The objectives of the study were to document the feasibility of distribution of misoprostol tablets by community-based providers mainly traditional birth attendants and acceptability and use of misoprostol by women who gave birth at home.
  
  
  METHODS
  A quasi-experimental design, comprising intervention and comparison areas, was used to document the acceptability of providing misoprostol tablets to pregnant women to prevent postpartum hemorrhage in the rural community setting in Pakistan. Data were collected using structured questionnaires administered to women before and after delivery at home and their birth attendants.
  
  
  RESULTS
  Out of 770 women who delivered at home, 678 (88%) ingested misoprostol tablets and 647 (84%) ingested the tablets after the birth of the neonate but prior to the delivery of the placenta. The remaining women took misoprostol tablets after delivery of the placenta. Side effects were experienced by 40% of women and were transitory in nature. Among women who delivered at home, 80% said that they would use misoprostol tablets in the future and 74% were willing to purchase them in the future.
  
  
  CONCLUSIONS
  Self-administration of misoprostol in the home setting is feasible. Community-based providers, such as traditional birth attendants and community midwives with proper training and counseling, play an important role in reducing postpartum hemorrhage. Proper counseling and information exchange are helpful for introducing new practices in resource-constrained rural communities. Until such a time that skilled birth attendance is made more universally available in the rural setting, alternative strategies, such as training and using the services of traditional birth attendants to provide safe pregnancy care, must be considered.
authors.affiliation: Population Council, Islamabad, Pakistan. amir@popcouncil.org
authors.forename: Ali Mohammad
authors.initials: AM
authors.lastname: Mir
authors.forename: Abdul
authors.initials: A
authors.lastname: Wajid
authors.forename: Sadaf
authors.initials: S
authors.lastname: Gull
mesh_terms: D000293:Adolescent; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006700:Home Childbirth / Q000193:education / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D008880:Midwifery / Q000193:education / Q000379:methods; D016595:Misoprostol / Q000627:therapeutic use*; D010120:Oxytocics / Q000627:therapeutic use*; D010154:Pakistan; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic / Q000379:methods*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D012424:Rural Population; D012646:Self Administration; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D010120:Oxytocics; D016595:Misoprostol