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REPRODUCTIVE HEALTH Improving the Understanding of What Works to Reduce Maternal Mortality and Improve Women's Reproductive Health Preventing Postpartum Hemorrhage in Gambia Postpartum hemorrhage is a leading cause of maternal deaths worldwide. In hospital-based studies, postpartum oral administration of misoprostol has had similar success in preventing postpartum hemorrhage to standard injectable treatments. Misoprostol offers several advantages over these standard regimens, including oral administration, long shelf life, stability at high temperature, and low cost. In collaboration with the Medical Research Council of the United Kingdom, the Population Council is conducting a community-based, randomized controlled trial of postpartum administration of misoprostol versus standard treatment to determine its effect on postpartum hemorrhage in rural Gambia. This is the first community-based trial to test the impact of this simple technology on postpartum hemorrhage. Safe Motherhood Demonstration Projects on Essential Obstetric Care Safe motherhood demonstration projects were conducted in Ghana and Vietnam to determine the impact of improving essential and emergency obstetric care in settings where medical care is scarce or quality of care problematic. Among the interventions tested, the most effective was a brief course on obstetric life-saving skills given to staff at primary (clinics) and secondary (district hospitals) care facilities. This intensive competency-based course increased the detection of life threatening obstetric conditions at both clinics and hospitals, but only improved the clinical management of these conditions in hospitals. The First-time Parents Project First births frequently occur to married adolescents. In Bangladesh, for example, nearly 75 percent of married women were under age 20 at the time of their first birth. Although fertility is falling in most of the developing world (and high-parity births, with their attendant risks, are declining), age at marriage and first birth remains low in many countries. Very young first-time mothers are at higher risk of pregnancy and birth complications, particularly obstructed labor, than women aged 20–35. First births are a potentially unique and powerful entry point into improving the prospects, including their reproductive and sexual health, of young, first-time mothers, and in setting patterns for future health-seeking behavior. The First-time Parents Project is being conducted to better understand the social moment and transition of a first birth, including the critical role of partners/fathers and other family members in decisionmaking and supportive/detrimental behaviors, so as to develop and test interventions that increase young women's social support; and tailor pregnancy, birth, and postpartum services to reflect this reality and be more broadly responsive to the reproductive and sexual health needs of women/girls having a first child. Improving the Quality of Maternal Care A project to improve approaches to providing quality maternal care in Kenya was conducted in conjunction with the Ministry of Health, the University of Nairobi, the Department of Obstetrics and Gynaecology, Kenya Medical Training College, and decentralized training centers. The goal of the project was to develop and implement a safe motherhood program model that can be applied to the majority of the country to reduce maternal and perinatal morbidity and mortality. This model, including interventions to improve access to and quality of health care from the grassroots level to hospitals, is being developed for two districts with distinct but typical health service structures. The feasibility, acceptability, quality, and effectiveness of alternative approaches was implemented, monitored and evaluated through defined process indicators. Supporting Fathers in Turkey The Population Council supported an education project to provide expectant fathers in ten large factories in Istanbul with information and support to promote family health during the pregnancy, birth, and newborn periods. This program is build on earlier research that demonstrated that providing information before a birth about pregnancy, childbirth, infant health, and postpartum women's health (including family planning), positively affected health behaviors after the birth, and more so if expectant fathers were also involved. See Also
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