$0.66 to save a woman’s life.
No, this isn’t some random campaign. It’s a pill that saves lives.
Hundreds of thousands of women are dying from entirely preventable causes.
Let’s talk about Maternal mortality.
I recently wrote a more in-depth article on maternal mortality (which you can read here). Today, I’ll only be covering the basics and walking you through this life-saving intervention.
- 99% of maternal deaths happen in the developing world, with postpartum hemorrhages (PPH) being the #1 killer.
- PPH is the extensive bleeding after birth. It happens for four key reasons, but the majority of cases occur because the uterus is unable to contract.
- In the “western world,” we have many solutions to PPH. One of the most effective lines of defence is uterotonic drugs.
- Utertonic drugs cause the uterus to contract. These contractions help mothers empty their uterus after birth, and stops any abnormal bleeding.
- Misoprostol, a uterotonic drug, is a magic-bullet solution for PPH. It effectively stops ~85% of bleeding. Physicians and global health professions praise it for its life-saving abilities in low-resource environments.
- Misoprostol is low-cost and easy to use. However, lack of education, limited Misoprostol supply in rural communities and initiative sustainability (reliance on grants) are holding us back from scaling this solution.
- If we engage the right stakeholders, this solution has the potential to save 100,000+ lives per year.
- We are building a distribution, training, monitoring and education plan to start a misoprostol initiative in Nigeria. We’re building a model that should not rely on grants, taps into local trust networks and leverages technology to speed up processes.
Postpartum Hemorrhages are the #1 Maternal Killer
PPH is severe loss of blood after delivery.
Women, especially those delivering at home or in unsuitable environments (spoiler: there’s a lot of them in the developing world) are bleeding to death because the uterus can’t contract properly.
After delivering a baby, women have to “deliver” their placenta (an organ that grows during the pregnancy to support the baby’s development). This is called afterbirth (appropriately so).
I’ll let you google what a placenta looks like.
Long story short: if the woman does not deliver her placenta correctly, there are repercussions. Mainly blood repercussions. AKA PPH.
Hemorrhages are estimated to be responsible for approximately 35% of maternal deaths in developing countries, although this varies widely across regions/countries.
Without intervention, 88% of women with PPH die within four hours of delivery.
Women dying from PPH generally don’t give birth in places like this:
They give birth in places like this:
(Yes, that’s a chicken).
What Causes PPH?
There are four causes of PPH — it’s helpful to just look at them in a pie chart 🥧.
Practically 90% of the problem comes down to the placenta being unable to exit the uterus.
Uterine Atony = when the uterine muscles get too weak. They are unable to “push.”
Trauma = trauma to the cervix, vagina, uterus, or any other system involved with removing the placenta. It “won’t work properly.”
So, how do we solve it?
By helping the placenta get out in one piece.
Often, after birth, the mother’s body is exhausted. (Rightfully so, she just pushed a 10-pound baby through her vagina).
Here’s the wild part: we have solutions to prevent PPH from getting out of control.
But women, giving birth with chickens, aren’t reaching these solutions.
Women are dying from a problem we’ve already solved.
My team, a team of 4 girls, thoughts this was absolutely stupid. STUPID. So for the past few weeks, we’ve been diving into postpartum hemorrhages, and how we can help distribute the solutions that already exist.
Uterotonics are the gold-standard for PPH.
Practically every woman in a country like Canada or Finland gets an IV of oxytocin after giving birth.
Why? Because oxytocin helps the uterus contract. Why? Science.
Oxytocin is a hormone that directly stimulates uterine contractions. It works a little something like this:
It produces prostaglandins, another set of hormones, which dilate the cervix to produce more oxytocin.
Given our goal in preventing PPH from happening is causing uterine contractions, it makes sense that oxytocin is the front-line of defence. That’s its job.
Uterotonics are analogues (similar to) oxytocin.
And, they work wonders. There are many types of uterotonics.
Our team built criteria to compare them and choose one to distribute to rural communities.
- Intervention with proven research that has a direct impact on reducing PPH
- Equipment exists in low-resource environments.
- Minimal staff training required.
- Can be stored in low-resource environments (i.e. with no electricity)
- Easily Transportable to remote, rural areas
- Few side-effects + limitations
- It doesn’t disturb the chickens 🐓 … ok, just kidding.
Here’s our comparison:
In low-resource environments, Misoprostol is the best option for women.
In high-resource environments, it’s usually the 2nd or third line of defence, always after oxytocin. But it still works well.
Misoprostol is a prostaglandin, so it indirectly causes contractions.
This makes it “slower” to act on. So, in environments where oxytocin is available, it makes sense to use it before Misoprostol.
Why is Misoprostol so great in low-resource environments?
🙌 It is proven to work to protect women from PPH. You can read some of our case studies here.
💊 Women can take Misoprostol as an oral pill, so it requires no extra equipment to administer.
👭You don’t need a medical degree to help properly administer Misoprostol. It requires very little human training.
📥 We can store Misoprostol at room temperature (oxytocin, for example, needs refrigeration). Many healthcare centres and homes don’t have proper electricity.
🚛It’s a tiny pill, so it doesn’t cause any transport bottlenecks.
💰It costs a matter of cents to buy from a supplier, even less to buy from a manufacturer.
👍No known severe complications. There are some side effects like nausea, contractions (shocking 😅), abdominal pain, etc., but nothing unbearable.
Compared to other uterotonics, it’s cheap, simple to use (just a pill), and does not require fancy hospitals or staff with Harvard degrees.
How exactly does it function?
Each woman after delivery takes around 600 micrograms, or three pills orally. They only have to take this dose once. This costs about $0.66.
After delivery is essential here. If a woman takes it before the baby is out [at too high of a dose], Misoprostol can cause abortion. (Because it can double as an abortion pill, you can see how there might be a stigma around it).
This sounds great. Why isn’t this everywhere?
This is the exact question my team has been biting on for the past few weeks.
Here are our findings.
So, for the past few weeks, we’ve been attempting to build a plan to address those challenges.
Ultimately, we want to help create a sustainable change in these societies.
Many successful Misoprostol initiatives rely on grants. They provide the drug for free. But this means that after a while, when the money dries, so does the drug supply.
We’re building a 4-pronged approach that distributes Misoprostol in places like Rural, Nigeria.
We’re working in Nigeria, specifically Jigawa State, Nigeria, because that’s where 1 in 5 maternal deaths happen.
Jigawa is one of the most dangerous places to give birth in the world. There are 1,012 maternal deaths per 100,000 live births.
We’re focusing our pilot in Jigawa. We will choose the exact community/local government area once we receive government approvals.
What are the parts of the pilot?
1: Distribution Networks
Misoprostol does not reach the hands (more like mouths, actually) of many women. In places like Jigawa, where 85%+ of the population lives in rural areas, travelling 20km to the pharmacy is unattainable.
We are tapping into the networks of Traditional Birth Attendants (TBAs) in these communities. TBAs are people that help women give birth, but they don’t have any formal medical education.
The important thing is they’re highly trusted by the community.
On top of TBAs, if available, we could use midwives. Either way, we are distributing the Misoprostol through a trusted front-line network.
Here is roughly what that would look like:
WDC = Ward Development Committees, they essentially store the drug and manage the CDKs.
CDK = Community drug keepers, they take the drugs from the WDCs and bring it to the front-line distributors.
TBAs/midwives = administer and deliver the drug to the women. Since community women trust them, this helps ensure women will accept Misoprostol.
2: Monitoring Drug Activity
There are several fears with Misoprostol:
- Women will use it for abortion
- Women will have the wrong dosage
- That the distribution stakeholders will re-sell the drugs on the black market, or provide counterfeit drugs
To ensure none of these concerns come true, we are in the process of designing a digital monitoring system that:
- Ensures Misoprostol is administered for PPH
- Ensures we track dosages given
- Ensures Misoprostol is Misoprostol, and there’s no weird activity attached to it.
3: Training distribution stakeholders, especially TBAs
Although Misoprostol protects a damn lot of cases, it doesn’t solve 100% of the problem.
And, if it’s administered incorrectly, it’s no longer as “amazing.”
We need to train administrators on how to administer it properly and monitor Misoprostol + the third stage of labour.
One bottleneck with scaling Misoprostol solutions is that training takes a long time and costs lots of money, mostly because it is so human-resource dependant.
We are working on our training protocol, which aims to teach TBAs how to administer Misoprostol and protect women against PPH. But, with an emphasis on scalability.
4: Educating all relevant stakeholders
We’ve had over 50 conversations about this issue. The constant issue and the silent killer is ignorance.
People don’t know.
They’re not educated.
Many of these women (and men ) can’t read nor write.
They also don’t speak english.
We’re developing an education strategy, which we’ll release soon, that emphasizes pictorial education, in local communication styles to teach women about why Misoprostol is essential.
Women are dying when they don’t need to be.
The reality is we don’t need crazy new inventions to reduce maternal mortality.
This isn’t a medical problem.
We have the answers, now let’s just bring them to the questions.