Project #951

Prevent Nigerian Mothers from Dying in Childbirth

by VSI, Venture Strategies Innovations

We are excited to report good news about our project introducing life-saving misoprostol tablets for prevention of excessive bleeding after childbirth, or postpartum hemorrhage (PPH), in northern Nigeria. This project is a collaborative effort with local partner Ahmadu Bello University Teaching Hospital and the Bixby Center at UC Berkeley, and since it began in January 2009, over 450 women have taken misoprostol after delivery to prevent life-threatening bleeding. This means 70% of the deliveries in the project area have been protected from PPH.

There is continued community involvement and commitment to “miso” as a new and effective way to reduce the high number of mothers dying in childbirth in this rural part of Nigeria, where a woman’s lifetime risk of dying from maternal causes is one in 18. In addition to monthly meetings about misoprostol hosted by each village chief, educational posters in English and Hausa about prevention of PPH with misoprostol are displayed in health facilities and around the project communities. Word is spreading quickly about the benefits of misoprostol. Women who live in villages not included in the project have come seeking out the life-saving tablets, citing the posters as the source of their interest.

We are excited by the developments in this project to save mothers’ lives in northern Nigeria and appreciate the support we receive from generous donors committed to reducing unnecessary maternal deaths.

Community dialogue attended by men and women
Community dialogue attended by men and women

In March, Venture Strategies and Bixby Center staff conducted a monitoring trip to the five project areas in Kaduna State where community-based delivery of misoprostol is underway under the direction of our local partner organizations Ahmadu Bello University Teaching Hospital and PRHP. Our staff witnessed true collaboration and a positive community response. Overall, about 1500 community members have participated in 18 dialogues, exceeding project targets. Importantly the male involvement piece has been integral in this largely Moslem area. The husbands are receiving messages about misoprostol for the prevention of postpartum hemorrhage and leave their name, address and wife’s due date, then midwives follow up and visit the pregnant mothers in their homes to distribute tablets.

Indeed, a clear strength of the project is the strong community involvement. Village chiefs are hosting regular monthly meetings in their homes for TBAs, patent medicine vendors (rural drug sellers), and community resource persons to further reinforce messages around misoprostol use for the prevention of postpartum hemorrhage. During extensive community dialogues local project staff worked with women to create awareness of too much blood loss after delivery. A local rubber cup used for drinking water, popularly called a “moda” was found to hold exactly 500 ml of water. This provided a clear visual representation for the community to understand when a woman had lost too much blood after delivery and was facing a life-threatening emergency. Because the dialogues took place during the fasting period, funds allocated for lunch were used to sew hijabs, the garb that Moslem women wear over their clothing, head ties for Christian women and butas for the Moslem men. Each of these items had an inscription in Hausa that read “Take three tablets of misoprostol immediately after birth to prevent PPH.”

Venture Strategies has made significant progress by incorporating policies and guidelines on the use of misoprostol for the prevention and treatment of postpartum hemorrhage into official policy documents for the government of Nigeria. These have far reaching implications on its integration in the healthcare system across the country and have enabled other organizations to initiate safe motherhood projects using misoprostol of their own. The net result is that misoprostol is nationally recognized as a key tool to save mothers’ lives due to excessive bleeding after childbirth and reduce the staggeringly high rate of maternal mortality in Nigeria, where 1 in 18 women die due to maternal causes.

Venture Strategies is expanding our own efforts in Nigeria. In November we began implementation of a community-based project in Kaduna state in conjunction with local partners. The project engages traditional midwives and birth attendants to administer misoprostol for prevention of PPH and will provide empirical evidence to inform policy makers on community-availability of misoprostol for home births. To date, sensitization of the participating communities was accomplished, trainings of providers in the facilities were completed, and traditional birth attendants were receiving their specialized training on Home-based Life Saving Skills and misoprostol for PPH. It is encouraging that the program has received support from religious and community leaders and the local emir himself attended the beginning of the traditional birth attendants’ training.

Following our active involvement in achieving the world's first regulatory approval of misoprostol for postpartum hemorrhage, Venture Strategies for Health and Development assisted in the preparation of the misoprostol clinical guidelines for physicians and nurses in Nigeria. These guidelines were recently approved by the Nigerian Family Ministry of Health after they convened a technical expert meeting.

The inclusion of misoprostol in the country's official clinical guidelines is a fundamental step towards ensuring that misoprostol is used at the facility level to control postpartum hemorrhage - excessive bleeding after childbirth.

Dissemination and sensitization on the newly approved clinical guidelines have begun for health care professionals throughout the country. These sensitization efforts are coinciding with ongoing training efforts to familiarize health care providers with Active Management of Third Stage Labor and the Judicious use of Misoprostol and distribution activities of the local distributor, Emzor.


In May 2007, Venture Strategies, in collaboration with our local partner Hygeia Nigeria Limited Foundation and under the guidance of Dr. Olawale Lawal Oyeneyin, completed training workshops on reducing maternal mortality and morbidity through Active Management of Third Stage of Labor (AMTSL) and the judicious use of misoprostol for the treatment of postpartum hemorrhage (PPH) in three key regions of the country: Lagos, Abuja, and Port Harcourt. In all, 228 healthcare providers, ranging from matrons and nurse midwives to MDs and medical directors were trained on AMTSL and the administration of misoprostol.

Pairs of one-day trainings were launched in February 2007 in Lagos which was attended by over 70 health professionals and the final trainings in Port Harcourt were held last month and attended by nearly 80 health care providers. Attendees represented the breadth of health facilities in the Hygeia Health Maintenance Organization’s extensive provider network. The trainings underscore the importance of misoprostol as an integral strategy to reduce maternal mortality. Primary objectives of the trainings were to improve the knowledge and attitude of health care workers in AMTSL and use of misoprostol, to increase the practice of AMTSL and use of misoprostol by healthcare workers at target facilities, and finally to empower trainees to become trainers themselves.

Venture Strategies is initiating the monitoring and evaluation phase of the AMTSL trainings, summer 2007.



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Organization Information

VSI, Venture Strategies Innovations

Location: Irvine, California - USA
Website: http:/​/​
VSI, Venture Strategies Innovations
Project Leader:
Allison Boiles
Communications Specialist
Anaheim, California United States

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Thanks to 205 donors like you, a total of $33,480 was raised for this project on GlobalGiving. Combined with other sources of funding, this project raised enough money to fund the outlined activities and is no longer accepting donations.

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