Teach Traditional Ethiopian Midwives to Save Lives

We have good news to report that Ethiopia is demonstrating global leadership in involving traditional birth attendants (TBAs) in the use of misoprostol for safe delivery. The endorsement of TBAs was spurred largely by the training of the government’s rural health extension workers on misoprostol that VS supported in four zones. A subsequent evaluation of that project documented positive results where TBAs and health extension workers were linked. Moreover our pioneering work with traditional midwives demonstrated that they could administer misoprostol safely to women after childbirth. Both projects demonstrate that these front-line health workers who operate in the most rural and underserved areas are the best means to deliver the life-saving misoprostol tablets to the women who need them most. The government is now moving ahead with plans to apply this health worker model to prevent maternal mortality from postpartum hemorrhage with misoprostol throughout the country.

Moreover, awareness on the importance of misoprostol has gained popularity among both the health care providers and the communities where misoprostol is being used. One head of a rural district health center had this to say to our program monitoring team, “Misoprostol has gained momentum so fast that women request for ‘the life saving drug which you have given to my neighbor when she delivered at your health center’. Referral for [complications of] postpartum hemorrhage has stopped [since we] started using misoprostol in the health center.”

In February 2008, Misoprostol Day, an innovative and successful information, education and communication campaign, was held at the annual Women’s Association meeting in the remote region of Tigray. The purpose of the campaign was to engender dialogue among influential women about misoprostol and develop a means to increase availability of the life-saving tablets. Women immediately identified with the message of birth preparedness and misoprostol as a feasible option for their deliveries. The conference highlighted education and empowered women to understand how misoprostol works, its importance for preventing death from excessive bleeding after childbirth and where they will be able to obtain the tablets in the near future. The results of the VSHD-sponsored operations research study with misoprostol distributed by traditional birth attendants in Tigray were also presented.

More than 800 female delegates representing constituents from the regional to village level attended, including high ranking representatives from other women’s groups from SNNPR, Dire Dawa, Harar, and Addis Ababa regions. Mrs. Azeb Mesfin, wife of the Prime Minister of Ethiopia and chair of the Social Affairs Committee in Parliament, expressed her commitment to ensuring that misoprostol is available throughout the entire country and women understand how to use it.

Ethiopia is the first country in the world to engage women’s groups on a large scale for share the knowledge of postpartum hemorrhage and misoprostol. Since the initial launch in Tigray, VSHD has implemented a similar strategy in Ahmara, Dira Dawa and Harar regionals and additional campaigns are planned throughout Ethiopia, as well as in other countries.