Postpartum hemorrhage

Initiative to Prevent Women from Bleeding to Death at Childbirth

Worldwide, post partum hemorrhage (bleeding after childbirth) typically causes around 130,000 maternal deaths a year, about 1/3 of all maternal deaths. Approximately 12 million women a year suffer excessive post partum hemorrhage according to a major Gates Foundation report. In parts of Niger, more than half the women who die at childbirth do so because of excessive bleeding.

Niger and HDI are teaming up for a nation-wide Initiative to Prevent Women from Bleeding to Death at Childbirth, using scientific advances endorsed by WHO.

Niger aims to give every birthing woman a dose of misoprostol, a heat-stable tablet that helps prevent excessive bleeding after birth by increasing uterine contractions. Medicines to prevent excessive bleeding after birth are effective in well over 90% of cases, when given right away. This simple intervention can be life-saving in a country where injectable medication cannot be given due to an unreliable cold chain and lack of injection supplies.

For those women who suffer excessive bleeding in spite of a timely preventive dose of misoprostol, HDI has combined three simple, effective, inexpensive technologies presented in Rome, into a Three-Step Treatment for Post Partum Hemorrhage.

Three-Step Treatment, when prevention is not enough:

STEP 1. An additional dose of the same medication, misoprostol.

STEP 2. A Tamponade Kit to use if she’s still bleeding after 20-30 minutes.

Created in Bangladesh, “Condom Tamponade” is an effective, low-cost alternative to very expensive “balloon catheters”. Condom tamponade is created by inserting a condom into a bleeding uterus and inflating it with water. This creates pressure against the bleeding surface, just as you apply pressure on lacerations of the skin to stop bleeding there.

A Tamponade Kit costs only $4.32, and can save a woman’s life. Each kit contains a catheter, a condom, a piece of string for tying the condom onto the catheter, a clamp to open and close the catheter, a syringe for filling the condom, a pair of examination-gloves, and a 10-day course of two antibiotics, to prevent infection.

Step 3. Non-inflatable Anti-Shock Garment (NASG), if she’s still bleeding 6-12 minutes after tamponade is applied.

Made of wet-suit material (neoprene) with Velcro closings, it takes 3 minutes to apply the NASG, which can prevent a woman from dying of shock and blood-loss during transportation to a “Definitive Treatment Hospital” that can perform life-saving surgery.

Developed at the University of California, San Francisco, this new yet proven technology costs $1 or less per use. Although NASGs cost $65, each can be applied 50-60 or perhaps 100 times when cleaned and disinfected correctly using an effective, low-cost approach.

To place an NASG in every “health hut”, health center, and hospital where women give birth, and one in every ambulance, Niger needs some 3,360 NASGs in all.

A baseline survey of maternal mortality, monthly data collection, and monthly supervision will allow us to document the efficacy of this national initiative, to make sure the government and external donors are spending their resources wisely. The aim is to do the baseline survey in late September and roll this initiative out across all of Niger in October 2013.

Niger is a big country. Inhabited by 16 million people, it is the size of France, Germany, Austria, Belgium, the Netherlands, and Denmark combined.

In late September 2013, the Government of Norway announced generous support of $664,000 USD (4 million Norwegian kroner), making it possible to start this ambitious initiative, to buy 65% of the misoprostol expected to be needed the first year, procure 1,100 anti-shock garments, undertake the needed Baseline Survey, and introduce this initiative to 2,700 doctors, nurses, and midwives across Niger. Still, additional funds need to be mobilized!

A couple of quarters (56 cents) buys the medicine needed to protect a woman’s life. $4.32 for a Tamponade Kit is enough to save one woman’s life when a treatment-dose of medication is not enough. $65 for a Non-Inflatable Anti-Shock Garment could save the lives of more than 50 new mothers.

Please help us reduce maternal death from hemorrhage by 50% within two years, and continue toward a 90% reduction as quickly as possible.

HDI (Health & Development International) is a registered 501 (c)(3) public charity in the US and an approved charitable organization in Norway (HDI-Norway). In both these countries, and the United Kingdom through Charitable Aid Foundation (CAF), donations in support of this work are tax-deductable to the full extent allowable.

Audited financial statements and other documentation are available for due-diligence purposes.

Please see other sections of this website for additional information about HDI, our track-record through 23 years, and other work we do to protect people’s dignity, socio-economic welfare, and in many cases their lives.

Anders R. Seim, MD, MPH
Founder and Executive Director