Interpretation of National Policy Regarding Community-Based Use of Misoprostol for Postpartum Hemorrhage Prevention in Ethiopia: A Tale of Two Regions

Introduction Postpartum hemorrhage (PPH) is responsible for a significant proportion of maternal mortality in developing countries. The uterotonic drug misoprostol (Cytotec) is a safe and effective means of preventing PPH. However, ministries of health in some countries are still grappling with poli...

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Published in:	Journal of midwifery & women's health Vol. 59; no. s1; pp. S83 - S90
Main Authors:	Spangler, Sydney A., Gobezayehu, Abebe Gebramariam, Getachew, Tewodros, Sibley, Lynn M.
Format:	Journal Article
Language:	English
Published:	United States Blackwell Publishing Ltd 01-01-2014 Wiley Subscription Services, Inc
Subjects:	Community based preventive programmes community-based interventions Comprehension Delivery of Health Care Developing Countries Ethiopia Female Goals Health Health Policy Hemorrhage Home Childbirth Humans International comparisons Interviews as Topic maternal health Maternal Mortality Midwifery misoprostol Misoprostol - therapeutic use Mortality Nursing Oxytocics - therapeutic use Postpartum Hemorrhage - prevention & control postpartum hemorrhage prevention Postpartum period Pregnancy Prevention Residence Characteristics Rural Population Ethiopia community-based interventions maternal health Ethiopia misoprostol postpartum hemorrhage prevention
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Summary:	Introduction Postpartum hemorrhage (PPH) is responsible for a significant proportion of maternal mortality in developing countries. The uterotonic drug misoprostol (Cytotec) is a safe and effective means of preventing PPH. However, ministries of health in some countries are still grappling with policy that addresses the implementation of this targeted intervention in community settings and with communicating this policy throughout the health care system. The purpose of this study was to examine understandings of national policy for community‐based use of misoprostol to prevent PPH in 2 regions of Ethiopia: Amhara and Oromiya. Methods Qualitative in‐depth interviews were conducted with a cohort of purposefully selected health officials (N = 51) representing various administrative levels of the Ministry of Health and influential nongovernmental organizations. Broad topics included national policy for PPH prevention, safety and effectiveness of community‐based use of misoprostol, and preferences for misoprostol administration. Interview transcripts were analyzed for key concepts both across and within administrative levels. Results Among all officials, understandings of national policy for community‐based PPH prevention using misoprostol were unclear. Officials in Amhara tended to adopt a strict interpretation that reflected fear of misuse and a deep concern for encouraging home birth (thus deviating from the clear national goal to increase facility‐based birth). Conversely, Oromiya officials framed policy in terms of the broader national goal to reduce maternal mortality, which allowed them to adopt multiple means of misoprostol distribution. Discussion The differences observed in regional practice likely stem from an ambiguously perceived national policy within a climate of decentralization that allowed for flexibility in local implementation. A policy that is clear, specific, evidence‐based, and systematically communicated may facilitate common understanding of community‐based misoprostol for PPH prevention and, thus, increase women's access to this lifesaving intervention.
Bibliography:	ark:/67375/WNG-X8CW75JW-6 istex:CF900743C7EEFE6A4EE5B1A0C55473E43D76E1A4 ArticleID:JMWH12154 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	1526-9523 1542-2011
DOI:	10.1111/jmwh.12154