After giving birth to each of her first two children, 23-year-old Margaret Nabiddo would bleed uncontrollably. “I would bleed every day, for almost a month,” she says.
Her third delivery was different. While she was pregnant with her third child, Margaret was given a comprehensive clean delivery kit during her last trimester. This maama kit, distributed in communities in a pilot project under the Maverick Collective Project, included misoprostol and chlorhexidine. The two were added to the Ministry of Health – recommended maama kit to reduce on unpreventable maternal health deaths.
Misoprostol, taken after the delivery of the baby (with confirmation that there is no other baby), helps to control postpartum bleeding while the chlorhexidine is used for the care of the newborn’s umbilical cord.
“I got my maama kit from Deo [Village Health Team] who spoke to me about the importance of going for antenatal visits and delivering in a health facility,” the resident of Lwemivubo Village in Kiyuni sub-county, Mubende says. Margaret received her antenatal care from Kiyuni Health Center III.
“When I got into labour, I knew there was no way I could reach the hospital so I decided to carry my kit to the nearer Kakigando Health Center II. After I delivered my baby and the placenta, the midwife gave me the three tablets to put under my tongue.”
Margaret’s bleeding stopped after one week. It was a different experience from her earlier deliveries where she bled for almost a month.
Globally, postpartum haemorrhage (excessive bleeding after childbirth) is the leading cause of maternal deaths. In Uganda, over 24% of maternal deaths are due to uncontrolled bleeding after childbirth. It is recommended that mothers be given oxytocin which helps to limit bleeding by stimulating uterine contractions.
However, oxytocin is difficult to store as it requires refrigeration and therefore near impossible to have available in resource-limited areas. Misoprostol on the other hand, can be stored at room temperature with a shelf life of up to two years, and therefore easy to distribute in remote areas that are less likely to have refrigerators and reliable electricity supply.
The Maverick Collective project in Uganda focused on the availability of the misoprostol to mothers in these settings in order to reduce preventable maternal deaths. The project distributed the pilot comprehensive clean delivery kits in five districts of Uganda, identified alongside Ministry of Health, as those where maternal mortality was relatively higher than national average.
For women like Margaret, the addition of misoprostol made their postpartum experience a more enjoyable and safer period.