Making Misoprostol widely available for home births in Afghanistan: New policy initiative


afghanistan pregnant mother

Photo A pregnant Afghan woman in rural Afghanistan


Afghanistan has one of the highest maternal mortality rates in the world. A mountainous environment combined with extreme weather conditions, extreme poverty, an almost 40 year history of ongoing conflict, conservative culture, and a nascent government have led to a country where qualified human resources in health are scarce. In addition, the above mentioned contextual factors have contributed to a state where more than 90% (estimated) of births take place at home.

Having worked in Afghanistan on a health systems strengthening evaluation project gave me a unique opportunity to witness some of the less visible realities. Most health facilities only carried Oxytocin whereas Misoprostol was hardly stocked.

Postpartum hemorrhage is by far the leading cause of maternal deaths worldwide. The lack of skilled health workers to properly administer an uterotonic creates an immense gap for all those who deliver at home without the use of a skilled birth attendant.

Various reputed international and national stakeholders (FIGO, ICM, RCOG, American Congress of Obstetricians and Gynecologists, and Afghan Midwives Association) have come out in support of Misoprostol as a viable option for preventing postpartum hemorrhage despite lack of sufficient evidence cementing its efficacy.

Research in Afghanistan has shown that community distribution of Misoprostol is safe and effective, and currently a clinical trial regarding the efficacy of Misoprostol is underway in Afghanistan. National policy makers are urged to forge ahead with new policy to mandate Misoprostol be effectively and comprehensively distributed nationally by front-line health workers, especially as countries such as Rwanda, Burundi, Angola, and Uganda have done so successfully for the last few years.


New mother in Afghanistan

Photo A new Afghan mother and her baby


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One Response to “Making Misoprostol widely available for home births in Afghanistan: New policy initiative”

  1. clairerichardson3 Says:

    This is a fantastic program that’s really trying to think outside of the box to mitigate an incredibly complex and difficult situation. Post-partum haemorrhage accounts for 25% of maternal mortality rates around the world primarily due to a delay in seeking care due to distance of lack of education.
    A similar program running in Nepal sends out village health workers during a woman’s pregnancy and distributing misoprostol. That way if the woman goes into labour without support then she’ll be able to take misoprostol on their own. It’s not the best solution but it has decreased MMR from 304 –> 74/100,000.
    I just love interesting and unique solutions to complex and longstanding problems.

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