Hope on the Horizon
USAID’s impact in reducing postpartum hemorrhage risk in India
On an early morning in December, Sanajana Tumria delivered a baby boy at Bagli Community Health Center in Madhya Pradesh, India. Mom and baby were healthy, and they spent the night recovering under the supervision of the midwifery staff.
Every story about a new baby should sound like this one.
Unfortunately, there are too many risks that can get in the way of that happy outcome. For Sanjana, heat-stable carbetocin, a heat-stable drug to prevent excessive bleeding after delivery, was a key factor in preventing a life-threatening emergency.
Heat-stable carbetocin is a relatively new drug formulation, and was added to the WHO essential medicines list in 2019 and approved for prevention of excessive bleeding due to childbirth wherever the cold chain is unclear. Despite that, applied evidence is scarce, and many countries are hesitant to introduce the new model in the absence of context-specific evidence.
Like many rural health facilities, Bagli Health Center is two hours away from the nearest public referral hospital, and much of that drive is done on bumpy dirt roads. Given as a single shot immediately after delivery, heat stable carbetocin helps contract the uterus to ensure women stop bleeding. It prevents the need for an emergency referral, and associated transport, to a far away referral hospital to treat postpartum hemorrhage.
Staff like it because it’s easy to use — it takes one injection, and they can see instant results.
Importantly, it does not have to be kept refrigerated, which means it does not rely on the cold chain–which can be challenging for some facilities to maintain or even access. And since it can withstand higher temperatures, it is a strong example of how USAID is adapting its programs to be more climate resilient, especially in increasingly hot climates, like India’s.
In most places, the norm for preventing deadly postpartum hemorrhage is oxytocin, which requires consistent cold temperatures to ensure that it works in the critical moment after delivery. This means that previously when a midwife at Bagli was delivering a baby, potentially alone and late at night, she was relying on the fact that the oxytocin was kept cold between the production factory and the national warehouse, and onward to the local pharmacy.
The midwife is assuming that the pharmacy kept the drug cold, that it was carried in a cooler to the facility, and that the refrigerator at the facility has worked consistently. Many providers and suppliers are not educated on the need for cold temperatures for oxytocin, so in areas with inconsistent electricity supply, it is more of a hope and less of a guarantee that the drug will work as intended.
In talking about carbetocin, the head of gynecology for District Hospital Dewas, Dr. Sadhna Varma says: “After carbetocin, our confidence that the bleeding will stop has increased. We don’t have to worry, we spend less time monitoring, and we spend less money on additional drugs.”
This is why USAID is partnering with the Government of Madhya Pradesh to roll out heat-stable carbetocin across all public facilities in the state. By developing training modules and generating evidence, USAID is partnering with the government to prove the effectiveness of the drug in reducing postpartum hemorrhage in the public sector.
The midwives at Bagli are such champions of this effort that they began to draw their own column in the register where they track births in order to document use of heat-stable carbetocin. This will help generate data that will benefit other states, and countries, especially as they explore the benefits of this drug in reducing postpartum hemorrhage.
Heat-stable carbetocin is being delivered in Dewas district of Madhya Pradesh alongside a larger government health initiative called LaQshya, which focuses on delivering quality and respectful care for improved outcomes around birth.
In Madhya Pradesh, the introduction of this commodity is already showing significant results.
Since heat-stable carbetocin was introduced last year in the district of Dewas, there have been no deaths due to PPH in mothers who received carbetocin, compared to several deaths in previous years, prior to the drug’s introduction.
Now, the Government of Madhya Pradesh is working on incorporating heat-stable carbetocin into their budget for the entire state, so they would take up the cost of the medication after this demonstration period. USAID also worked with the drug producer to ensure that costs are manageable for public facilities, securing a 95% discount on the market price.
Demonstrating the impact of carbetocin to prevent postpartum hemorrhage is one part of USAID’s efforts to validate new models, respond to government requests to fill gaps in evidence, and help target government resources toward sustainable improvements in health, with the potential for global application.
Following the success of this approach in India, USAID has shared job aids created in India with Madagascar to support health provider learning and retention and build the evidence base to drive widespread use of heat stable carbetocin to prevent postpartum hemorrhage.
About the Author
USAID’s Office of Maternal and Child Health and Nutrition, which works to ensure that all women and children have the same chance of a healthy life, regardless of where they live or are born.
About the Partner
IPE Global is a USAID partner based in India that provides urban planning, urban management, and sustainable infrastructure development solutions that focus on human development and poverty alleviation.
