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Every two minutes a woman in the world's poorest regions dies needlessly from pregnancy or childbirth-related complications due to lack of access to basic medicines
In a world accustomed to expensive, high-tech health care, the inexpensive, low-tech solutions often get overlooked - with fatal results for women and their babies.
Every two minutes a woman in the world’s poorest regions dies needlessly from pregnancy or childbirth-related complications due to lack of access to three basic, affordable and widely available medicines, according to PATH, an international nonprofit that focuses on high-impact, low-cost solutions to improve global health.
Drugs like oxytocin, misoprostol and magnesium sulfate are essential to treat the two leading causes of maternal death: postpartum haemorrhage, which is excessive bleeding after childbirth, and pre-eclampsia and eclampsia, which are caused by high blood pressure during pregnancy.
All three of them cost less than $1 per dose.
Yet more than 8 million women annually suffer from postpartum hemorrhage and nearly 71,800 of them die, according to PATH’s recent report, “Safeguarding pregnant women with essential medicines.”
The administration of oxytocin by injection or misoprostol in tablet form might have saved those lives, according to PATH.
It estimated that if oxytocin and misoprostol were available to all women giving birth, over 41 million cases of postpartum haemorrhage could be prevented and 1.4 million lives saved over a 10-year period.
An estimated 63,000 women annually die from pre-eclampsia and eclampsia, conditions characterized by high blood pressure during pregnancy that, if left untreated, can lead to seizures, kidney and liver damage, and ultimately death.
Many of those deaths also might have been prevented with injections of magnesium sulfate, according to PATH.
The problem lies not in the availability of these medicines globally but in bottlenecks in the supply chains, Catharine Taylor, PATH’s global program leader of maternal and child health and nutrition, told TrustLaw.
Funding gaps may also be an obstacle but they are often compounded by faulty national and local supply chains which are unable to forecast need, she said.
As a result medicines either are not purchased and distributed in time or are purchased so far ahead of need that they expire or degrade due to poor storage practices.
In her experience, Taylor said, clinics may send the husband of a labouring woman out to buy a drug like oxytocin at a local pharmacy. PATH did a small study of oxytocin purchased that way in Ghana and found that only 25 percent of the drug had active ingredients.
“The problem is they’re often not drugs that are procured globally by an institution like the GAVI Alliance, UNFPA or UNICEF,” she said, referring to organisations that purchase in bulk and impose quality control standards.
“They’re often procured directly by the government of the country and so sometimes it’s difficult for them to maintain the supplies, so you get stock-outs,” she said, adding that procurement can be further complicated if the drug is not easily available within the country.
Such problems with the logistics of supply and demand have long been overlooked by governments and the international community, according to PATH.
Finally, they are being addressed by the recently established United Nations Commission on Life-Saving Commodities for Women and Children, which is part of the UN’s Every Woman, Every Child initiative.
In its first report published in September, the commission looked at 50 countries with high maternal death rates and examined the availability of 13 essential medicines that address causes of death during pregnancy, childbirth and into childhood. Oxytocin, misoprostol and magnesium sulfate were at the top of the list.
The commission, co-chaired by Nigerian President Goodluck Jonathan and Norwegian Prime Minister Jens Stoltenberg, made a number of recommendations that urge states to use bulk buying, local manufacturing and innovative marketing to improve the supply chain, track demand and streamline distribution of medicines.
“There are so many competing interests out there for politicians, planners, policymakers,” said Taylor, who served as co-chair of the commission’s working group on innovation.
“If you talk to any of them as individuals, they’ll say, of course, that’s a no-brainer - but when they’re writing up their plans, particularly in ministries of health…it’s really difficult.”,.
Noting that health ministers often report to ministers of finance, she said that an economic argument about the concrete benefits to the country of providing lifesaving medicines to women and children might be most persuasive.
“A maternal death has a cost both at the family level and within the community because of her lost production, if you like,” Taylor said.
“If there’s maternal morbidity, she’s a less productive member of society and if she has a child that’s malnourished…their ability to contribute to society going forward (is compromised).”
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