title: Uterotonic use during childbirth in Uttar Pradesh: accounts from community members and health providers.
abstract: OBJECTIVE
  this qualitative study aimed to document provider and community practices regarding uterotonic use during labour and delivery in Uttar Pradesh, India, as well as the knowledge, attitudes, and values that underlie such use.
  a total of 140 in-depth interviews were conducted between May and July 2011 in Agra and Gorakhpur districts, with clinicians, nurses, recently delivered women, mothers-in-law with at least one grandchild, traditional birth attendants, unlicensed village doctors, and pharmacist assistants at chemical shops.
  
  
  RESULTS
  interviews reveal that injectable uterotonic use for the purposes of labour augmentation is widespread in both clinical and community settings. However, use of uterotonics for postpartum haemorrhage prevention and treatment appears to be relatively limited and was rarely discussed by respondents. Key beliefs underlying uterotonic use were identified, including high valuation of labour pain, rapid delivery, and biomedical intervention, particularly administration of medicines. Other factors promoting the use of uterotonics for labour augmentation included lack of knowledge about adverse effects, provider beliefs that prolonged labour poses risks to the baby, community perceptions that modern women are less able to have spontaneous delivery, and financial incentives for uterotonic administration.
  
  
  CONCLUSIONS
  major challenges to overcome in minimising uterotonic misuse include entrenched use for labour augmentation in both institutional and community deliveries, perceptions of injectable uterotonics as curative agents symbolic of biomedical care, and the widespread availability of these drugs. The findings demonstrate a need for programmes that reduce inappropriate use of uterotonics, promote appropriate use for postpartum haemorrhage prevention and treatment, and ensure adherence to evidence-based guidelines.
authors: Johns Hopkins Bloomberg School of Public Health, 455 Massachusetts Ave. NW, Washington, DC 20001, USA. ellie.mirzabagi@gmail.com
authors: Ellie
authors: E
authors: Mirzabagi
authors: Nitya Nand
authors: NN
authors: Deepak
authors: Alissa
authors: A
authors: Koski
authors: Vandana
authors: V
authors: Tripathi
mesh_terms: D000328:Adult; D003153:Community Health Services; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007194:India; D010120:Oxytocics / Q000627:therapeutic use*; D036801:Parturition / Q000187:drug effects*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D036301:Qualitative Research; D012111:Residence Characteristics
chemical_list: D010120:Oxytocics
keywords: Home delivery; India; Institutional delivery; Uterotonics