POSTPARTUM HAEMORRHAGE

To exclusively breastfeed, mums need to stay alive

Excessive bleeding during or after childbirth is the biggest killer of women in Africa.

In Summary
  • These deaths can and should be prevented.
  • Two uterotonics have been included on the essential drugs list by WHO, but most African countries are yet to include them on their lists
A breastfeeding mother.
A breastfeeding mother.

The world marks breastfeeding week from August  1 to 7 annually to bring attention to the need for mothers to be supported to exclusively breastfeed their babies for the first six months of life and up to two years. Unfortunately, a high number of women do not get to breastfeed their children because they never make it out of the delivery room alive.

This year’s theme was ‘Support breastfeeding for a healthier planet’. As noble as this is, postpartum haemorrhage presents a huge challenge to women in sub-Saharan Africa. The success of exclusive breastfeeding is highly dependent on whether mothers come out of the delivery room alive.

Excessive bleeding or postpartum haemorrhage during or after childbirth is the biggest killer of women in Africa. According to the World Health Organization, about 295,000 women died during and after pregnancy and childbirth in 2017. Sub-Saharan Africa alone accounted for roughly two-thirds (196,000) of these.

 

These deaths can and should be prevented.

WHO, based on extensive new evidence, recommended two drugs for prevention and treatment of bleeding in women on its model list of essential medicines in 2019. If these are implemented they will contribute to the reduction in maternal deaths, especially in low and middle-income countries.

Administration of an effective uterotonic (these are drugs that help the uterus to contract and help reduce blood loss during childbirth) immediately after birth has been shown to prevent PPH caused by the uterus failing to contract. It is recommended by WHO for all births.

Currently, most low- and middle-income countries use oxytocin injection as the first line medicine for the prevention and treatment of PPH. Oxytocin is a heat-sensitive product that degrades when it is not kept refrigerated in temperatures of 2-8°C throughout the supply chain, which can result in reduced effectiveness at the time of use, particularly in countries where reliable electricity and cold chain may not be available.

Besides, many copycats have infiltrated the market.

The drugs recommended by WHO to help the uterus go back to ‘its setting” after delivery include heat-stable carbetocin. This drug retains its effectiveness for at least 36 months when stored at temperatures up to 30°C.

The other – Tranexamic Acid – is not a new drug and has been used for many years to reduce blood loss during surgery for trauma patients. While it had previously not been a go-to drug for reducing bleeding during birth, WHO has now included it in the 2019 list of essential medicines with an obstaetric indication—treatment of PPH.

 

While these medicines have been included on the essential drugs list by WHO, most African countries are yet to include them on their lists.

For mothers to exclusively breastfeed, they need to stay alive after delivery, for them to stay alive, we need to include drugs that work and that can maintain their efficacy even in resource-strapped areas to save the lives of mothers and to contribute to the reduction of maternal mortality.

Policy adviser, WACI Health