Community-based Prevention of Postpartum Hemorrhage in Rural Bangladesh

Background: In rural Bangladesh, rates of home deliveries are among the highest in the world, with 90% of women delivering at home, the vast majority without skilled attendants. Since expansion of the skilled workforce is expected to be slow, interventions are needed to reduce maternal mortality in the interim. We assessed the feasibility, acceptability, and efficacy of a community-based strategy to prevent postpartum hemorrhage, a major contributor to maternal mortality ratios in Bangladesh. Methods: 465 traditional birth attendants employed by a Bangladeshi NGO participated in a two-day training in home-based use of oral misoprostol and an absorbent mat, which indicates when a threshold of 500ml blood loss is reached. Knowledge, attitudes and practices of birth attendants were measured at baseline and tracked at three points during the study period, ending at 1 year post-implementation. 64 in-depth interviews with birth attendants complemented quantitative assessments. Results: Birth attendants' knowledge and access to misoprostol prior to the study was virtually non-existent, but immediately after the training 99% of trainees stated the correct dosage, route and timing of administration. Misoprostol and the mat were clearly welcomed by birth attendents and communities, with over 90% of women offered misoprostol and the mat electing to use both interventions. The mat provided attendents with a useful communication tool to help reduce the delay in hospital transfer decisions. Conclusions: Community-based distribution of misoprostol and a delivery mat by trained and supported traditional birth attendants is a viable way to prevent postpartum hemorrhage during home births.