Misoprostol for the prevention of post-partum haemorrhage in Mozambique: an analysis of the interface between human rights, maternal health and development

Abstract

Background: Mozambique has high maternal mortality which is compounded by limited human resources for health, weak access to health services, and poor development indicators. In 2011, the Mozambique Ministry of Health (MoH) approved the distribution of misoprostol for the prevention of post-partum haemorrhage (PPH) at home births where oxytocin is not available. Misoprostol can be administered by a traditional birth attendant or self-administered. The objective of this paper is to examine, through applying a human rights lens, the broader contextual, policy and institutional issues that have influenced and impacted the early implementation of misoprostol for the prevention of PPH. We explore the utility of rights-based framework to inform this particular program, with implications for sexual and reproductive health programs more broadly.Methods: A human rights, health and development framework was used to analyse the early expansion phase of the scale-up of Mozambique's misoprostol program in two provinces. A policy document review was undertaken to contextualize the human rights, health and development setting in Mozambique. Qualitative primary data from a program evaluation of misoprostol for the prevention of PPH was then analysed using a human rights lens; these results are presented alongside three examples where rights are constrained. Results: Structural and institutional challenges exacerbated gaps in the misoprostol program, and sexual and reproductive health more generally. While enshrined in the constitution and within health policy documents, human rights were not fully met and many individuals in the study were unaware of their rights. Lack of information about the purpose of misoprostol and how to access the medication contributed to power imbalances between the state, health care workers and beneficiaries. The accessibility of misoprostol was further limited due to dynamics of power and control.(Continued on next page)

Law, human rights and gender in practice: an analysis of lessons from implementation of self-care interventions for sexual and reproductive health

“…Only four articles explicitly mentioned human rights 28 , 33 , 40 , 50 only one of which went beyond simply mentioning a right and actually provided detailed human rights analysis. 33 Many articles referenced principles that could be interpreted to be related to human rights, but lacked a systematic human rights framing.…”

“…Only four articles explicitly mentioned human rights 28 , 33 , 40 , 50 only one of which went beyond simply mentioning a right and actually provided detailed human rights analysis. 33 Many articles referenced principles that could be interpreted to be related to human rights, but lacked a systematic human rights framing. Across the literature, despite some attention to rights there is a striking lack of attention to participation and accountability, even as both are deemed important for use and uptake of self-care interventions.…”

“… 28–30 , 32 , 34 , 35 , 39 , 41–48 Ten articles compared perceptions between men and women regarding self-care interventions. 6 , 12 , 19 , 33 , 37 , 38 , 49 , 50 , 51 , 74 Eight articles studied self-care interventions among transgender populations. 20 , 22 , 52–57 The only articles focused exclusively on cisgender men were about men who have sex with men.…”

“…Most often mentioned in the literature are policies recently passed surrounding specific self-care interventions, 7 , 22 , 31 , 37 , 38 , 66 as well as those that serve as barriers to self-care implementation. 19 , 27 , 29 , 33–36 , 39 , 44 , 45 …”

Midwives’ experiences of reducing maternal morbidity and mortality from postpartum haemorrhage (PPH) in Eastern Nigeria

“…Although misoprostol is not as effective as oxytocin, it is mostly used as first line drug of choice in low socioeconomic settings because it is less expensive and can be readily stored [ 42 ]. Misoprostol given by trained health care workers is effective and safe for the prevention of PPH [ 43 ]. Although oxytocin has great impact in reducing PPH, its quality and impact on PPH decreases because of its sensitivity to heat and the need of appropriate storage in a cold chain [ 44 ].…”