title: Community-based misoprostol for the prevention of post-partum haemorrhage: A narrative review of the evidence base, challenges and scale-up.
abstract: Achieving Sustainable Development Goal targets for 2030 will require persistent investment and creativity in improving access to quality health services, including skilled attendance at birth and access to emergency obstetric care. Community-based misoprostol has been extensively studied and recently endorsed by the WHO for the prevention of post-partum haemorrhage. There remains little consolidated information about experience with implementation and scale-up to date. This narrative review of the literature aimed to identify the political processes leading to WHO endorsement of misoprostol for the prevention of post-partum haemorrhage and describe ongoing challenges to the uptake and scale-up at both policy and community levels. We review the peer-reviewed and grey literature on expansion and scale-up and present the issues central to moving forward.
authors.affiliation: a Menzies School of Health Research , Charles Darwin University , Darwin , Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Hobday
authors.affiliation: b Department of Emergency Medicine , University Health Network, University of Toronto , Toronto , Canada.|c Department of Family and Community Medicine , University of Toronto , Toronto , Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hulme
authors.affiliation: a Menzies School of Health Research , Charles Darwin University , Darwin , Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Belton
authors.affiliation: d Centre for Midwifery, Child and Family Health, Faculty of Health , University of Technology Sydney , Ultimo , NSW , Australia.
authors.forename: Caroline Se
authors.initials: CS
authors.lastname: Homer
authors.affiliation: e Bixby Center for Population Health and Sustainability, School of Public Health , University of California , Berkeley , CA , USA.
authors.forename: Ndola
authors.initials: N
authors.lastname: Prata
mesh_terms: D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000494:pharmacology*; D003153:Community Health Services; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage / Q000494:pharmacology*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy
chemical_list: D000897:Anti-Ulcer Agents; D016595:Misoprostol
keywords: Misoprostol; advance distribution; community-based; post-partum haemorrhage; scale-up