Postpartum Hemorrhage Prevention in Nepal: A Program Assessment

As part of broader efforts to improve the safety of childbirth, the Nepal Ministry of Health launched in 2009 a national postpartum hemorrhage (PPH) prevention program featuring the advance provision of misoprostol to pregnant women for use during home births. In this South Asian country, approximately two-thirds of women deliver at home with no skilled birth attendant and an estimated quarter of all maternal deaths are due to PPH, a rare life-threatening condition of childbirth.

In 2013, a Gynuity-sponsored assessment of the program was conducted in nine districts and all three ecological regions — mountain, hill and terai (flatland terrain) — of Nepal. Interviews were conducted with 2,070 women who had recently given birth to assess knowledge, receipt and use of misoprostol. Interviews were also conducted with 270 Female Community Health Volunteers (FCHVs) and staff at 99 health facilities to assess the supply and provision of misoprostol.

Program Assessment Findings

Recommendations for Strengthening the Program

Conclusion
The supply and personnel challenges identified raised questions about the scalability and impact of the program over the long-term. A re-assessment at a later time is recommended.

Read more
Postpartum hemorrhage prevention in Nepal: a program assessment, Rajbhandari et al. BMC Pregnancy and Childbirth 2017; Volume 17:169 (available in open access).

The program assessment was carried out by the Ministry of Health and Population, Nepal; Gynuity Health Projects; and New ERA. The national PPH prevention program also features the provision of oxytocin during facility-based births.

Gynuity Health Projects is a research and technical assistance organization which works globally to ensure that reproductive and maternal health technologies are widely available at reasonable cost, provided in the context of high-quality services, and offered in a way that recognizes the dignity and autonomy of each individual. Our efforts are focused particularly on resource-poor environments, underserved populations, and challenging subject matter. For further information, visit our website www.gynuity.org and follow us on Twitter @Gynuity.