Maama Knows Best

by Rebecca Babirye, Malaria and Child Survival Program Manager, Programme for Accessible Health Communication and Education (PACE) @paceUganda

Postpartum hemorrhage (PPH), or excessive bleeding after childbirth, is the leading cause of maternal mortality in Uganda, and pregnant women in Uganda learn to recognize its signs. To decrease the risk of PPH and ensure a safe delivery, most expecting Ugandan mothers use Maama Kits, which include every World Health Organization (WHO)-recommended tool a mother needs for a safe delivery—sterilized and neatly packed to the size of a sleeping bag—for deliveries at clinics and in homes.

And soon, every one of these convenient kits will include two additional medications, recognized by the United Nations as essential life-saving commodities: chlorhexidine to sterilize the baby’s umbilical stump, and misoprostol, which the mother can take herself to prevent or treat heavy bleeding, as it contracts her uterus to stop the flow of blood.

© PACE/Kalungi Kabuye

In 2016, Sara Ojjeh, a founding member of Maverick Collective, PSI’s philanthropy and innovation lab, invested in a pilot program led by PACE, PSI’s network member in Uganda. The investment aimed to reduce the high rates of maternal and neonatal mortality in Uganda.

Thirty-four percent of maternal deaths in Uganda are due to PPH, according to estimates from the Uganda Demographic Health Survey. These unnecessary deaths can be reduced with misoprostol. Most Ugandan health facilities use oxytocin to control postpartum bleeding, but it requires refrigeration. In low-resource areas where oxytocin is not readily available, misoprostol—which can be stored at room temperature—is a valuable alternative. Although the drug has been registered in Uganda for over nine years, it has not been accessible to expecting mothers for deliveries at clinics, or for the 27 percent of Ugandan mothers who give birth at home.

The project aimed to change the Ministry of Health (MOH) guidelines to include chlorhexidine and misoprostol in Maama Kits and make them available for distribution at the community level. PACE’s project, with Ojjeh’s investment, was piloted in five districts with high maternal mortality to test if community distribution of misoprostol could contribute to a reduction in maternal mortality.

PACE distributed 25,000 kits, which included misoprostol and chlorhexidine. All of the women who received the kits were monitored through delivery and postnatal care to track maternal outcomes. In the targeted districts, about nine of every 1,000 women reported experiencing bleeding before or after birth. During the course of the project, bleeding declined to almost half its previous rate: only five out of 1,000 women reported bleeding.

With the investment in the pilot project, PACE was not only able to test community distribution of misoprostol, but with the positive results, they were also able to successfully advocate for changes to government guidelines including:

  1. Uganda’s MOH added the inclusion of chlorhexidine and misoprostol to the list of safe delivery guidelines.
  2. The MOH approved the inclusion of misoprostol in community distribution guidelines.
  3. The current manufacturer of misoprostol only packages the drug in blister packs of 10 tablets, though the prescribed dosage to prevent PPH is only three tablets. The National Drug Authority approved three tablet blister packs of misoprostol to be made in Uganda.

Despite these wins, there’s still more work to be done for mothers in Uganda.

More funding is needed to find a manufacturer for the three tablet blister packs of misoprostol. And where the pilot project found success in five districts, further investment could ensure that the new, more powerful Maama Kits are available nationwide. Every Ugandan woman deserves access to a Maama Kit complete with chlorhexidine and the correct dose of misoprostol so that more mothers will be there for their children, and more children will thrive into adulthood.

Ugandan mothers know when something is wrong, and they know what it takes to fix it. A Maama Kit puts the power of a safe delivery right in their hands.

—With contribution from Maria Dieter, Associate Content Manager, PSI, @mariadeets

This article appears in PSI’s Impact magazine, released in tandem with Women Deliver 2019, as part of an ongoing conversation about putting #PowerInHerHands.

Banner Image: A ProFam ambassador (left) shows a Maama Kit to an expecting mother (right) outside her home in the town of Lweza, Uganda. © PACE/Kalungi Kabuye

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