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Postpartum Hemorrhage Prevention in Nepal: A Program Assessment

As part of an ongoing effort to promote safer motherhood, Nepal launched in 2009 a national PPH prevention program featuring the advance provision of misoprostol to pregnant women for use during home births. A Gynuity-sponsored assessment of the program was conducted in nine districts and all three ecological regions — mountain, hill and terai/flatland terrain — of the country. To assess knowledge, receipt and use of misoprostol, household interviews were conducted with 2070 women who had given birth within the past 12 months. To assess supply and provision of misoprostol, interviews were conducted with 270 Female Community Health Volunteers (FCHVs) and staff at 99 health facilities. Findings showed that among recently delivered women, only 15 per cent received information about misoprostol and 13 per cent received misoprostol tablets in advance of delivery. However, 87% of women who received advance misoprostol were both willing and able to use the medication for PPH prevention. The evaluation also revealed widespread shortages in the supply of misoprostol at health facilities and among FCHVs, and some gaps in program-related knowledge and practices related to advance distribution of misoprostol for PPH prevention. The supply and personnel challenges identified raise questions about scalability and impact of the program over the long-term. The authors recommend further assessment.

Access the full article (available in Open Access) BMC Pregnancy and Childbirth 5 June 2017; Vol 17: 169.