This project will save women’s lives by expanding access to, and use of, antihypertensive drugs and magnesium sulfate to prevent and treat pre-eclampsia and eclampsia.
Each day, about 830 women die from preventable causes related to pregnancy and childbirth. The second most common cause is pre-eclampsia—the rapid rise of blood pressure during pregnancy—which, if untreated, can lead to seizures (eclampsia), kidney and liver damage, and death. Babies born prematurely because their mothers experienced pre-eclampsia and eclampsia are also at higher risk of dying.
The World Health Organization recommends magnesium sulfate as the safest, most effective, and lowest-cost treatment for severe pre-eclampsia and eclampsia, although availability and correct use of this lifesaving drug varies widely. The need for magnesium sulfate is greatest in low-income countries of sub-Saharan Africa and South Asia, where pregnancy and childbirth are less safe and 65%–85% of the population is rural, with limited access to life-saving health care.
This project builds on related Population Council research and interventions in Bangladesh, Mexico, and Nigeria funded in 2007 by the MacArthur Foundation to improve the availability and correct use of magnesium sulfate in maternal health care settings.
Council research in Nigeria between 2008 and 2011 demonstrated that providing training to health service providers on the provision of magnesium sulfate resulted in a 40% reduction in maternal mortality and a 68% reduction in the contribution of eclampsia to maternal mortality in 10 pilot hospitals. Training expanded to 35 additional facilities. From 2011 to 2014 the Council advocated for policy change to allow use of magnesium sulfate at primary health care centers prior to hospital referral, and a national curriculum for preservice training was developed and introduced into 164 schools of nursing, midwifery, and health and technology.
In Bangladesh, project activities included training a range of service providers to identify and treat pre-eclampsia and eclampsia, and establishing functional referrals between community and referral facilities. And in Mexico, public health officials are using findings from the Council’s 2008 study to identify potential strategies to increase health care professionals’ awareness of, confidence in, and willingness to use magnesium sulfate to treat pre-eclampsia and eclampsia.
The USAID-funded Ending Eclampsia project expands program activities in Bangladesh, Ethiopia, Kenya, Nigeria, and Pakistan and will be undertaken in partnership with national obstetrician/gynecologist and midwifery societies to:
- Expand successful interventions in Kenya, Bangladesh, Ethiopia, Nigeria, and Pakistan by improving the ability of community health care providers to identify pregnant women at risk of pre-eclampsia and eclampsia during high-quality antenatal and postnatal care and prevent the progression to pre-eclampsia and eclampsia by providing antihypertensive drugs for management of high blood pressure and administering a loading dose of magnesium sulfate to women with severe pre-eclampsia or eclampsia and referring them to secondary facilities for further management.
- Develop a Primary Healthcare PE/E Model that outlines essential linkages between communities and health systems for quality care for pregnant women with high blood pressure and other promising practices based on Council research that increase access to, and use of, early antenatal and postnatal care, antihypertensive drugs, and magnesium sulfate;
- Align project efforts with the World Health Organization, USAID-supported maternal health projects, and other major initiatives such as the Reproductive Health Supplies Coalition, the Bill & Melinda Gates Foundation’s PRECISE project, the International Society for the Studies of Hypertension in Pregnancy, the Taskforce on Women and Non-Communicable Diseases, and the Partnership for Maternal Newborn and Child Health (PMNCH).
- Develop an international “Global Coalition” to share resources and lessons learned and inform strategies to introduce and expand the use of magnesium sulfate and other interventions to prevent, detect, and manage pre-eclampsia and eclampsia within the context of routine maternal health care.
Findings from Ending Eclampsia will change the global conversation on maternal mortality, putting a greater focus on this preventable cause of death, and will be used to improve access to life-saving care for the approximately 3 million women at risk of pre-eclampsia and eclampsia every year.