Utilizing the informal health sector to reach women delivering at home with life-saving interventions: Traditional birth attendants distributing misoprostol to prevent postpartum hemorrhage at home births in Mozambique

In Mozambique, maternal mortality is high at a rate of 520 maternal deaths per 100,000 live births. Postpartum hemorrhage (PPH) is a leading cause of maternal mortality. Misoprostol is a tablet that has the potential to reduce PPH-related maternal mortality and morbidity in low-resource settings since the recommended injectable drugs to prevent PPH are infeasible in communities where the majority of women deliver at home without a skilled provider. Traditional birth attendants (TBAs) serve as a critical opportunity to distribute misoprostol to women who do not access the formal health care system during pregnancy and delivery. In one district of Mozambique, TBAs were trained to conduct community and one-on-one education meetings on excessive bleeding, and provide women with misoprostol at deliveries they attended from November 2009 through October 2010. TBAs were linked to the formal health care system through meetings with their supervisor at the local health center. 2,441 women delivered with these TBAs and all took misoprostol at delivery. All but two women took the correct dose. TBAs reported that less than 1% of women experienced excessive bleeding, referring them for additional interventions. These results demonstrate that TBAs can safely use misoprostol at home deliveries. This project strengthened the link between the informal and formal health sectors by reaching women normally not reached by the formal health care sector with a life-saving intervention and facilitating needed referrals of women experiencing PPH at home births.