Confronting maternal mortality due to postpartum hemorrhage and unsafe abortion: a call for commitment.

In July 2012, in Dar es Salaam, Tanzania, more than 35 obstetrician/gynecologists, nursemidwives and public health professionals working in Africa recommitted to and reinvigorated their efforts towards achieving Millennium Development Goal (MDG) 5 at a Regional Experts’ Summit. During the weeklong conference convened to explore the myriad factors contributing to maternal mortality in the 12 African countries represented, the experts identified solutions that exist today, and that can be made available on a large scale to confront preventable maternal deaths. One such solution, misoprostol, is a simple and effective medicine that can contribute significantly to our efforts to reduce maternal mortality. Given its status as a safe and effective medicine that is both heat-stable and easy to administer, the potential of misoprostol to save women’s lives is largely untapped. Misoprostol is recognized by the World Health Organization (WHO) as an essential medicine for addressing two major causes of maternal mortality: postpartum hemorrhage (PPH) and unsafe abortion 1, 2 . FIGO, the International Federation of Gynecology and Obstetrics, also recommends misoprostol for all of its obstetric and gynecologic indications, including prevention and treatment of PPH, treatment of incomplete abortion, treatment of missed abortion, medical abortion, cervical ripening and induction of labor 3 . WHO’s 2012 guidelines recommend the provision of misoprostol for prevention of PPH by community health care workers and lay health workers where skilled health workers and oxytocin are not available 4 . This is in addition to its inclusion in the WHO’s Safe Abortion Technical and Policy Guidance for Health Systems in combination with mifepristone or alone for termination of pregnancy 5 . Backed by these policy endorsements and peerreviewed literature, and drawing upon a breadth of experiences of introducing misoprostol for maternal health throughout Africa, the experts identified three primary activities that must be accelerated now to save more women’s lives in our communities, and our countries.