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Results for Women: URC projects worldwide make life-saving interventions a part of routine health care for women and their newborns

Posted: International Women’s Day, March 8, 2010

Mrs. Ganze, with her husband and two children. Her story illustrates the impact of AMTSL, a life-saving intervention.

Mrs. Ganze, a mother of two, in Benin, suffered a life-threatening postpartum hemorrhage (PPH) after giving birth to her first child. Even after being transferred to a hospital and receiving emergency care, she did not regain consciousness for 10 hours. “When it came time to give birth to my second child,” she explained, “I expected the worst.”

But, she said, “to my immense relief,” delivery at the Zogbodomey Maternity Center went “remarkably well.” The Center is located in Zou, one of the provinces where URC is working with the government of Benin to introduce Active Management of Third Stage of Labor (AMTSL), a clinical practice proven to reduce the incidence of PPH.

URC's USAID-funded Integrated Family Health Program has made rapid progress in supporting government facilities to apply AMTSL as part of routine childbirth care. As facilities began using AMTSL (73% in 2008 to 98% in March 2009), PPH rates decreased by over half (1.5% to 0.7%).

Empowering front-line providers to administer life-saving interventions for women

In developing countries worldwide, URC projects strengthen national health care systems to ensure that providers apply life-saving practices as part of routine health services for women. AMTSL is one example of the evidence-based practices URC promotes. Most URC projects introduce AMTSL as part of a comprehensive reproductive and maternal newborn health program that includes family planning, antenatal, childbirth, and postpartum services. (Download Preventing postpartum hemorrhage: Why quality improvement matters.)

Expanding proven approaches to save women's lives

Our projects tailor implementation and scale-up methods to a country's context and needs. Ecuador and Niger are two examples, among many, of countries where URC has successfully scaled up a high-impact practice, such as AMTSL, within a comprehensive women’s health program.

Team of health professionals and traditional midwives in Ecuador

Ecuador: Introducing and taking Active Management of Third Stage Labor to national scale

In 2003, URC vigorously advocated to introduce AMTSL into Ecuador’s national maternal care program. Initially, many of the country’s policymakers, managers, and senior obstetricians expressed concern about AMTSL’s safety and effectiveness. To address their reservations, URC proposed introducing AMTSL on a pilot basis in a single province as part of a comprehensive Essential Obstetric Care Improvement initiative.

As the initiative grew, an increasing number of facilities implemented AMTSL, demonstrating that providers could safely administer the practice in various types of facilities. In 2010, nearly 60% of all government facilities providing childbirth care in Ecuador reported routine compliance with AMTSL standards. The Ministry of Health, in partnership with URC, is now leading a countrywide initiative to spread AMTSL to all government facilities providing maternal health care.

Midwife team in a Niger maternity

Niger: Accelerating postpartum hemorrhage prevention in a high-mortality setting

Click on image to view larger graph. In Niger, AMTSL increased from < 5% to 98%; PPH decreased from 2.5% to 0.2%, a 92% decrease.

In 2005, when URC launched a maternal-newborn improvement initiative in Niger, a country with the highest maternal mortality rate in the world, few maternal health providers practiced AMTSL. Teams from over 33 government maternity facilities collaborated intensively to improve maternal newborn care.

During the initiative's first phase, the team focused on improved immediate postpartum care through the introduction of AMTSL and Essential Newborn Care. Two years later, AMTSL coverage of births in participating facilities (where nearly a third of all facility births occur) increased from less than 5% to 98%, and the PPH rate decreased from 2.5% to 0.2%, a 92% decrease. Eight months after the initiative ended in 2009, URC’s research demonstrated that sites were continuing to practice AMTSL at levels achieved during the project.

For more information on URC’s work to improve reproductive health and maternal and newborn care worldwide, please contact Dr. Youssef Tawfik at ytawfik@urc-chs.com.

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