Fighting Maternal Mortality in Nepal with Misoprostol
The earthquakes that shook Nepal in late April and early May were declared the country’s worst natural disaster on record. The quakes claimed the lives of 8,800 people and injured 22,000 others. The mass destruction and death toll continue to have devastating effects on all aspects of the country’s well-being. The Nepalese people are trying to rebuild and reclaim the sense of normalcy that existed before the quakes, but the earthquakes’ effects have presented new challenges.
Before the storm, increasing amounts of Nepalese women were choosing to have their babies in health facilities — a choice that helped Nepal meet the United Nations Millennium Development Goal in the reduction of maternal mortality rates by three-quarters. Another major factor in the massive reduction of such rates is a decade-old decision to distribute misoprostol to women who need it. Misoprostol is a drug designed to treat stomach ulcers, but is also capable of terminating a pregnancy when taken early on, and preventing postpartum hemorrhage — the leading cause of maternal death — when taken after giving birth.
The decision to distribute the powerful drug as a means to decrease maternal mortality lacked international support largely because the hegemonic ideology is that the best way to improve maternal mortality rates is to invest in making health facilities more accessible. While the idea of creating hundreds of well-stocked and adequately staffed health centers that are available to all mothers is a good one and would certainly reduce maternal mortality rates, overall it is unrealistic for many developing countries. The reality is that in developing countries where there have been large government expenditures on improving facilities, maternal mortality rates have not improved as significantly as they have in Nepal.
Since the massive earthquake struck, expectant mothers face additional challenges and there is concern that the mortality rates could increase again. With the destruction of roads and many healthcare facilities, giving expectant mothers misoprostol makes even more sense.
Currently, distributing the misoprostol amidst the widespread destruction is a major issue in Nepal. Aid groups, such as Direct Relief, have been working with the International Confederation of Midwives (ICM) and the Midwifery Society of Nepal (MIDSON), to deliver midwife kits, tents and funds. The intervention program focuses on providing midwives and the tools that they require, including misoprostol, to give Nepalese mothers the best chance at having a healthy delivery.
When access to midwives and trained professionals is as severely limited as it is in Nepal, there needs to be a backup plan. Few countries have followed in Nepal’s footsteps but if Nepal’s success has been any indication, misoprostol could be an intermittent solution that could work for many developing countries. In time, we will see how Nepalese maternal mortality rates fare in the aftermath of the horrific disaster. If the low rates are upheld, perhaps the international community will reconsider responsible use of misoprostol to get countries maternal mortality rates down, until the large scale investments in facilities and infrastructure can be made.
– Emma Dowd
Sources: Economist, Foreign Policy, Military Technologies, Reuters
Photo: Women News Network