South Sudan: Saving Lives by Preventing Postpartum Hemorrhage

South Sudan: Saving Lives by Preventing Postpartum Hemorrhage

A woman receiving antenatal care in South Sudan. {Photo credit: J. Warren/Save the Children.}Photo credit: J. Warren/Save the Children.

On a dark August night in rural South Sudan, Linda Kenneth felt the swift kick of labor pains begin. Having previously delivered five children, Linda recognized the pains and immediately called for the nearby skilled birth attendant, as it was too late in the evening for her to travel safely to the health facility. In her previous two pregnancies, she had experienced heavy bleeding after delivering, and worried similar complications might arise this time.

South Sudan has the world’s worst maternal mortality ratio (2,054 deaths per 100,000 live births), and roughly one third of these deaths can be attributed to postpartum hemorrhage (PPH). Administration of misoprostol or another uterotonic (a drug that reduces bleeding after childbirth) could prevent the majority of these deaths. Misoprostol does not require a cold supply chain, and is cheap and effective, making it a perfect candidate for community-based interventions.

Upon the birth attendant’s arrival, Linda presented the three misoprostol pills she had recently been given by a home health promoter. Several days prior, a home health promoter had visited Linda and discussed with her a birth preparedness plan, informing her of the benefits of taking misoprostol immediately after delivery to prevent excessive bleeding.

In 2012, in partnership with the United States Agency for International Development (USAID)’s Maternal and Child Health Integrated Program (MCHIP), the USAID-funded second phase of the Sudan Health Transformation Project (SHTP II) initiated a PPH prevention project. The project trained and equipped both community-based home health promoters and facility-based health workers to provide misoprostol pills to pregnant women after 32 weeks.

SHTP II also trained home health promoters to counsel all pregnant women on the importance of having a birth preparedness and complication readiness plan and provide them with misoprostol and instructions to take the pills immediately after delivery to prevent PPH.

SHTP II, MCHIP, and Jhpiego designed and field-tested educational materials, and then selected more than 180 home health promoters to use these materials during home visits and counseling sessions with pregnant women. As of September 2012, the project has trained 69 home health promoters, and plans to train 180 in total by the end of the project.

When Linda took the pill after delivery, her uterus contracted, and she delivered the placenta without further complications. Unlike her previous two deliveries, she experienced no excessive bleeding.

Linda became the second project beneficiary to successfully take misoprostol to prevent PPH. Just three days before in a nearby community, Alice Nyalia was the first person reached by the project to take the drugs. Both Alice and Linda delivered healthy baby girls, and these women and babies are continuing to thrive.

Erin Polich, MPH, is SHTP II communications officer for Management Sciences for Health in Juba, South Sudan.