Protecting Women Who Deliver at Home from PPH with Misoprostol: Distribution of Misoprostol through Antenatal Care in Tanzania

New strategies to prevent postpartum hemorrhage (PPH) for women who deliver at home are urgently needed in low-resource settings. Antenatal care (ANC) is one possible mechanism for misoprostol distribution: in Tanzania, 94% of women receive antenatal care yet 53% of deliveries take place at home.

This presentation provides an overview of operations research conducted in four districts of Tanzania. During routine ANC care, providers emphasize facility delivery but also educate women on using misoprostol for PPH prevention, and dispense misoprostol to women > 32 weeks gestation for use at home births if they cannot go to a health facility for delivery. In addition, a community education campaign on birth preparedness and PPH prevention was ongoing in project areas to increase awareness of the importance of safe delivery. To date, 4,829 participants enrolled in the study, of whom only 2,529 took misoprostol home from ANC (52%) due to the gestational age requirement. Misoprostol coverage at home deliveries was high (91%), resulting in an additional 35% of births “protected” that otherwise would have been vulnerable to PPH. There was no significant decrease in health facility birth rates. All women who used misoprostol after a home delivery used it correctly. Acceptability of misoprostol was very high among women. This project demonstrated that distribution of misoprostol to pregnant women during ANC was safe, feasible and effective to provide PPH prophylaxis for home deliveries. Policy makers in Tanzania and other countries with high rates of home deliveries should scale-up misoprostol distribution at ANC.