Reflecting on Storeng and Béhague ("Lives in the balance": the politics of integration ... more Reflecting on Storeng and Béhague ("Lives in the balance": the politics of integration in the Partnership for Maternal, Newborn and Child Health. Health Policy and Planning Storeng and Béhague (2016).) historical ethnography of the Partnership for Maternal, Newborn and Child Health (PMNCH), this commentary provides a more current account of PMNCH's trajectory since its inception in 2005. It highlights PMNCH's distinct characteristics and how it is positioned to play an instrumental role in the current global health landscape.
The co-sponsors of the conference pledged to fulfill the recommendations of the call to action an... more The co-sponsors of the conference pledged to fulfill the recommendations of the call to action and stated their willingness to provide technical and financial support to developing country governments that request help in designing and implementing programs to ensure Safe Motherhood. Barber B. Conable, president of the World Bank, announced plans to double the Bank's lending for population, health, and nutrition projects to about $500 million annually by 1990, with projects in some fifty countries. In addition, the World Bank and the U.N. Development Program declared that they will each contribute $1 million to the establishment of a Safe Motherhood Fund. The fund will support operational research in specific countries for the development and improvement of maternal health programs, and will be administered by the World Health Organization. The participants at the conference emphasized that maternal health care, including family planning, is an essential and integral element of primary health care programs aimed at the goal of health for all by the year 2000. As the discussions made clear, saving women's lives is a practical goal as well as a humanitarian one. Women's contributions and productivity are visible not only in the infants they nurture, but in the food they grow, harvest, and cook; in the variety of goods they produce and market; in the teaching and care of their children; in the many tasks they perform every day to serve their families and communities. The death of an infant's mother results not only in the loss of a woman in the prime of her life, but also in the loss of her economic productivity, usually the death of her infant, and in some cases the disintegration of her family.
Countdown 2015 Sexual and Reproductive Health and Rights For All, Mar 22, 2015
Every minute somewhere in the world a woman dies from the complications of pregnancy and childbir... more Every minute somewhere in the world a woman dies from the complications of pregnancy and childbirth—530000 deaths per year. Less than 1 percent of these deaths occur in the developed world. One out of every 61 women in developing countries dies while trying to give birth compared to one out of every 2800 in developed countries. Country-specific figures are even more telling: pregnancy complications kill one out of every 10 women in Ethiopia compared to one out of every 29800 in Sweden. No other common health indicator shows such a stark discrepancy between rich and poor countries. Deaths are not the full story. For every woman who dies at least 30 others suffer acute complications—15 million per year. Many of these complications are long-term and often debilitating. They include infertility severe anaemia and damage to the reproductive organs. The most common causes of maternal death and disability in developing countries as a whole are well-known and easily managed via clinical interventions that are standard practice in the developed world. (excerpt)
Assessment of the potential for international dissemination of Ebola virus via commercial air tra... more Assessment of the potential for international dissemination of Ebola virus via commercial air travel during the 2014 west African outbreak. Lancet 2014; published online Oct 21. 6736(14)61828-6. 5 WHO Ebola Response Team. Ebola virus disease in West Africa-the fi rst 9 months of the epidemic and forward projections.
The end of 2015 will signal the end of the Millennium Development Goal era, when the world can ta... more The end of 2015 will signal the end of the Millennium Development Goal era, when the world can take stock of what has been achieved. The Countdown to 2015 for Maternal, Newborn, and Child Survival (Countdown) has focused its 2014 report on how much has been achieved in intervention coverage in these groups, and on how best to sustain, focus, and intensify efforts to progress for this and future generations. Our 2014 results show unfinished business in achievement of high, sustained, and equitable coverage of essential interventions. Progress has accelerated in the past decade in most Countdown countries, suggesting that further gains are possible with intensified actions. Some of the greatest coverage gaps are in family planning, interventions addressing newborn mortality, and case management of childhood diseases. Although inequities are pervasive, country successes in reaching of the poorest populations provide lessons for other countries to follow. As we transition to the next set of global goals, we must remember the centrality of data to accountability, and the importance of support of country capacity to collect and use high-quality data on intervention coverage and inequities for decision making. To fulfill the health agenda for women and children both now and beyond 2015 requires continued monitoring of country and global progress; Countdown is committed to playing its part in this effort.
The views expressed in all papers are tlwse of the autlwrs or the organisation as specified in th... more The views expressed in all papers are tlwse of the autlwrs or the organisation as specified in the paper, and slwuld not be attributed to the agencies or organisations sponsoring the Safe Motherhood Confertmce. BACKGROUND RAP.ERS 55 BACKGROUND PAPERS FOR SAFE MOTHERHOOD CONFERENCE
Recent years have seen an unprecedented surge of global attention to maternal, newborn, and child... more Recent years have seen an unprecedented surge of global attention to maternal, newborn, and child health (MNCH). However, despite repeated commitments and calls for action, no major, specifi c new funding has been directed at the MNCH continuum of care during the past 12-18 months. A UN event in September, 2009 resulted in strong rhetorical and-it seemed-fi nancial commitments. But of the US$5•3 billion nominally pledged at that event, almost none was specifi cally for MNCH programmes; rather, it was promised broadly to commodities, health-system strengthening, and vaccines. 1 These pledges, if fulfi lled, will improve maternal and child health outcomes by strengthening overall health services, but will not necessarily generate new funds for essential MNCH interventions, including: family planning; skilled care during and after pregnancy and childbirth; safe abortion, when legal; immediate postnatal care for mother and newborn child; and improved child nutrition and management of childhood illnesses. Will this situation change? Will key policy makers respond to calls for greater resources to realise the targets for the health Millennium Development Goals (MDGs) 4 (improve maternal health), 5 (reduce child mortality), and 6 (combat HIV/AIDS, malaria, and other diseases)? That remains to be seen. But an extraordinary combination of initiatives and opportunities in the coming months could prompt revolutionary funding changes and concrete actions by donors, countries, and other contributors. The UN Secretary-General's Joint Action Plan for fulfi lment of MDGs 4 and 5, announced in mid-April, 2 aims to mobilise key champions and generate defi nite policy, programme, and funding commitments, including an additional $15 billion for 2011, to realise the vision set out in the Global Consensus for Maternal, Newborn and Child Health. 3 The plan builds on widely accepted policies and programmes, and an accountability framework will track what pledges are made and met. Canadian Prime Minister Stephen Harper intends to make maternal and child health (MCH) the top priority at the G8 Summit this June. Last year, G8 governments declared warm support for the global MNCH consensus; 4 this year's support must become more concrete. A commitment to allocate at least 0•1% of gross national income to health assistance, as recommended by the Commission on Macroeconomics and Health, 5 would constitute an excellent start. A global funding mechanism whose mandate specifically includes reproductive, maternal, newborn, and child health (RMNCH) would be crucial to mobilise needed resources. The options are to add RMNCH to the mandate of an existing mechanism, or to needed services, such as the emergency obstetric services recommended by WHO. 12
Background The Countdown to 2015 for Maternal, Newborn, and Child Survival initiative monitors co... more Background The Countdown to 2015 for Maternal, Newborn, and Child Survival initiative monitors coverage of priority interventions to achieve the Millennium Development Goals (MDG) for reduction of maternal and child mortality. We aimed to report on 68 countries which have 97% of maternal and child deaths worldwide, and on 22 interventions that have been proven to improve maternal, newborn, and child survival. Methods We selected countries with high rates of maternal and child deaths, and interventions with the most potential to avert such deaths. We analysed country-specifi c data for maternal and child mortality and coverage of selected interventions. We also tracked cause-of-death profi les; indicators of nutritional status; the presence of supportive policies; fi nancial fl ows to maternal, newborn, and child health; and equity in coverage of interventions. Findings Of the 68 priority countries, 16 were on track to meet MDG 4. Of these, seven had been on track in 2005 when the Countdown initiative was launched, three (including China) moved into the on-track category in 2008, and six were included in the Countdown process for the fi rst time in 2008. Trends in maternal mortality that would indicate progress towards MDG 5 were not available, but in most (56 of 68) countries, maternal mortality was high or very high. Coverage of diff erent interventions varied widely both between and within countries. Interventions that can be routinely scheduled, such as immunisation and antenatal care, had much higher coverage than those that rely on functional health systems and 24-hour availability of clinical services, such as skilled or emergency care at birth and care of ill newborn babies and children. Data for postnatal care were either unavailable or showed poor coverage in almost all 68 countries. The most rapid increases in coverage were seen for immunisation, which also received signifi cant investment during this period. Interpretation Rapid progress is possible, but much more can and must be done. Focused eff orts will be needed to improve coverage, especially for priorities such as contraceptive services, care in childbirth, postnatal care, and clinical case management of illnesses in newborn babies and children.
20 years ago the global health community came together to highlight the most striking inequity in... more 20 years ago the global health community came together to highlight the most striking inequity in public health: half a million women 99% of them in the developing world were dying every year in pregnancy and childbirth. High fertility inadequate and inaccessible health services and womens low status meant that women in the poorest regions of the world were 500 times more likely to die from pregnancy-related complications (one in 20 risk) than women in northern Europe (one in 10 000 risk). The global Safe Motherhood Initiative was launched to generate political will identify effective interventions and mobilise resources that would rectify this horrifying injustice. Today 20 years into the initiative maternal mortality has declined in some regions especially in middle-income countries in Latin America and northern Africa as documented by Ken Hill and colleagues in todays Lancet. But dismally we are nowhere near the goals of reduction of global maternal mortality by 50% (the target setin 1987) or 75% (the target set by Millennium Development Goal [MDG] 5 accepted by the UN and heads of state in 2000). Progress has been achieved in other areas including much greater awareness of the issue and an enormous increase in knowledge about what works and what does not. But without substantial decreases in maternal mortality what is there to celebrate in 2007? As the 20th anniversary approached this dilemma was faced by the agencies organisations donors and individuals who helped launch the initiative. (excerpt)
The decisions by Ortho Pharmaceutical in 1985 to suspend manufacture and sale of the Lippes Loop ... more The decisions by Ortho Pharmaceutical in 1985 to suspend manufacture and sale of the Lippes Loop IUD and by G.D. Searle and Co. to suspend sales of the copper 7 and copper T 200 IUDs in the US have virtually eliminated the IUD as a potential contraceptive method for American women. The only remaining IUD on the US market is the little used Progestasert hormone-releasing IUD, which accounted for only 3% of the US market at the time of Searle's decision. The decisions were made as a direct result of the liability insurance crisis and the high cost of lawsuits in the US. The US legal system, unlike those of many countries, permits individuals who believe they have been injured by actions, inactions, or products of individuals, companies, or governmental organizations to sue. The number of such lawsuits rose by 680% in US federal courts between 1974-84, and the average damages awarded now exceed US $1 million. The phenomenon of joint responsibility, in which the plaintiff can sue all parties who can be defined as having had responsibility for the alleged injury, is particularly worrisome for industry. In practice this often means that plaintiffs concentrate their efforts on the party able to pay the greatest amount in damages. As the volume of lawsuits and damages awarded have skyrocketed, so has the cost of liability insurance. Some insurance companies simply refuse to insure high risk ventures at any price. Causes of the insurance crisis in the US are multiple, but one important factor is the new unwillingness of much of the public to accept any risks in return for benefits such as control of fertility. The Lippes loop has been the object of about 200 lawsuits and the Searle IUDs of about 800, 400 of which have been dismissed or settled out of court. Of those going to court, Searle won 9 and lost 2. Legal fees in 4 recent cases won by Searle exceeded $1.5 million. Alza Corp., manufacturer of the Progestasert, is now making the device available to all physicians requesting it, but Alza urges physicians to obtain informed consent and includes a 7-page pamphlet with each device. Each unit costs $84 compared to the $25 or so for copper IUDs, and each must be replaced annually. Many satisfied users and family planning personnel in the US are dismayed by the disappearance of an effective method from the market. Although there is no objective reason for the termination of IUD use in the US to affect the availability of IUDs in other countries, the continued distribution of IUDs elsewhere has aroused suspicion. The International Planned Parenthood Federation, Family Health International, other family planning organizations, and the US Agency for International Development have examined the records of the IUD and have reiterated their conviction that the method is safe and effective for appropriately selected users. They emphasize that the IUD has the unqualified approval of the US Food and Drug Administration.
International Journal of Gynecology & Obstetrics, 2013
New global guidance has emerged to support countries as they consider introducing or scaling-up m... more New global guidance has emerged to support countries as they consider introducing or scaling-up misoprostol for postpartum hemorrhage (PPH). The World Health Organization (WHO) and the International Federation of Gynecology and Obstetrics (FIGO) recognize the critical role that community and lay health workers play in preventing PPH and increasing access to misoprostol where skilled birth attendants are not available. As case examples from Nigeria and Nepal illustrate, community engagement and empowerment are critical strategies in successful misoprostol for PPH programs, and must increasingly be viewed as part of efforts to improve maternal health and achieve Millennium Development Goal 5.
International Journal of Gynecology & Obstetrics, 2011
Clinical and operational evidence indicates that misoprostol is a safe and effective technology f... more Clinical and operational evidence indicates that misoprostol is a safe and effective technology for addressing postpartum hemorrhage, a major cause of maternal death. This research has not yet been translated into effective policies, programs, and practice in many parts of the world. Efforts to expand evidence-based use of misoprostol are often complicated by misoprostol's range of indications, insufficient availability, a lack of evidence-based guidelines and provider training, and misconceptions about the drug. The medical and health policy communities need to work together to translate research findings into changes in policy, knowledge, and clinical practice so that we can deliver on the world's promise to improve maternal health.
Reflecting on Storeng and Béhague ("Lives in the balance": the politics of integration ... more Reflecting on Storeng and Béhague ("Lives in the balance": the politics of integration in the Partnership for Maternal, Newborn and Child Health. Health Policy and Planning Storeng and Béhague (2016).) historical ethnography of the Partnership for Maternal, Newborn and Child Health (PMNCH), this commentary provides a more current account of PMNCH's trajectory since its inception in 2005. It highlights PMNCH's distinct characteristics and how it is positioned to play an instrumental role in the current global health landscape.
The co-sponsors of the conference pledged to fulfill the recommendations of the call to action an... more The co-sponsors of the conference pledged to fulfill the recommendations of the call to action and stated their willingness to provide technical and financial support to developing country governments that request help in designing and implementing programs to ensure Safe Motherhood. Barber B. Conable, president of the World Bank, announced plans to double the Bank's lending for population, health, and nutrition projects to about $500 million annually by 1990, with projects in some fifty countries. In addition, the World Bank and the U.N. Development Program declared that they will each contribute $1 million to the establishment of a Safe Motherhood Fund. The fund will support operational research in specific countries for the development and improvement of maternal health programs, and will be administered by the World Health Organization. The participants at the conference emphasized that maternal health care, including family planning, is an essential and integral element of primary health care programs aimed at the goal of health for all by the year 2000. As the discussions made clear, saving women's lives is a practical goal as well as a humanitarian one. Women's contributions and productivity are visible not only in the infants they nurture, but in the food they grow, harvest, and cook; in the variety of goods they produce and market; in the teaching and care of their children; in the many tasks they perform every day to serve their families and communities. The death of an infant's mother results not only in the loss of a woman in the prime of her life, but also in the loss of her economic productivity, usually the death of her infant, and in some cases the disintegration of her family.
Countdown 2015 Sexual and Reproductive Health and Rights For All, Mar 22, 2015
Every minute somewhere in the world a woman dies from the complications of pregnancy and childbir... more Every minute somewhere in the world a woman dies from the complications of pregnancy and childbirth—530000 deaths per year. Less than 1 percent of these deaths occur in the developed world. One out of every 61 women in developing countries dies while trying to give birth compared to one out of every 2800 in developed countries. Country-specific figures are even more telling: pregnancy complications kill one out of every 10 women in Ethiopia compared to one out of every 29800 in Sweden. No other common health indicator shows such a stark discrepancy between rich and poor countries. Deaths are not the full story. For every woman who dies at least 30 others suffer acute complications—15 million per year. Many of these complications are long-term and often debilitating. They include infertility severe anaemia and damage to the reproductive organs. The most common causes of maternal death and disability in developing countries as a whole are well-known and easily managed via clinical interventions that are standard practice in the developed world. (excerpt)
Assessment of the potential for international dissemination of Ebola virus via commercial air tra... more Assessment of the potential for international dissemination of Ebola virus via commercial air travel during the 2014 west African outbreak. Lancet 2014; published online Oct 21. 6736(14)61828-6. 5 WHO Ebola Response Team. Ebola virus disease in West Africa-the fi rst 9 months of the epidemic and forward projections.
The end of 2015 will signal the end of the Millennium Development Goal era, when the world can ta... more The end of 2015 will signal the end of the Millennium Development Goal era, when the world can take stock of what has been achieved. The Countdown to 2015 for Maternal, Newborn, and Child Survival (Countdown) has focused its 2014 report on how much has been achieved in intervention coverage in these groups, and on how best to sustain, focus, and intensify efforts to progress for this and future generations. Our 2014 results show unfinished business in achievement of high, sustained, and equitable coverage of essential interventions. Progress has accelerated in the past decade in most Countdown countries, suggesting that further gains are possible with intensified actions. Some of the greatest coverage gaps are in family planning, interventions addressing newborn mortality, and case management of childhood diseases. Although inequities are pervasive, country successes in reaching of the poorest populations provide lessons for other countries to follow. As we transition to the next set of global goals, we must remember the centrality of data to accountability, and the importance of support of country capacity to collect and use high-quality data on intervention coverage and inequities for decision making. To fulfill the health agenda for women and children both now and beyond 2015 requires continued monitoring of country and global progress; Countdown is committed to playing its part in this effort.
The views expressed in all papers are tlwse of the autlwrs or the organisation as specified in th... more The views expressed in all papers are tlwse of the autlwrs or the organisation as specified in the paper, and slwuld not be attributed to the agencies or organisations sponsoring the Safe Motherhood Confertmce. BACKGROUND RAP.ERS 55 BACKGROUND PAPERS FOR SAFE MOTHERHOOD CONFERENCE
Recent years have seen an unprecedented surge of global attention to maternal, newborn, and child... more Recent years have seen an unprecedented surge of global attention to maternal, newborn, and child health (MNCH). However, despite repeated commitments and calls for action, no major, specifi c new funding has been directed at the MNCH continuum of care during the past 12-18 months. A UN event in September, 2009 resulted in strong rhetorical and-it seemed-fi nancial commitments. But of the US$5•3 billion nominally pledged at that event, almost none was specifi cally for MNCH programmes; rather, it was promised broadly to commodities, health-system strengthening, and vaccines. 1 These pledges, if fulfi lled, will improve maternal and child health outcomes by strengthening overall health services, but will not necessarily generate new funds for essential MNCH interventions, including: family planning; skilled care during and after pregnancy and childbirth; safe abortion, when legal; immediate postnatal care for mother and newborn child; and improved child nutrition and management of childhood illnesses. Will this situation change? Will key policy makers respond to calls for greater resources to realise the targets for the health Millennium Development Goals (MDGs) 4 (improve maternal health), 5 (reduce child mortality), and 6 (combat HIV/AIDS, malaria, and other diseases)? That remains to be seen. But an extraordinary combination of initiatives and opportunities in the coming months could prompt revolutionary funding changes and concrete actions by donors, countries, and other contributors. The UN Secretary-General's Joint Action Plan for fulfi lment of MDGs 4 and 5, announced in mid-April, 2 aims to mobilise key champions and generate defi nite policy, programme, and funding commitments, including an additional $15 billion for 2011, to realise the vision set out in the Global Consensus for Maternal, Newborn and Child Health. 3 The plan builds on widely accepted policies and programmes, and an accountability framework will track what pledges are made and met. Canadian Prime Minister Stephen Harper intends to make maternal and child health (MCH) the top priority at the G8 Summit this June. Last year, G8 governments declared warm support for the global MNCH consensus; 4 this year's support must become more concrete. A commitment to allocate at least 0•1% of gross national income to health assistance, as recommended by the Commission on Macroeconomics and Health, 5 would constitute an excellent start. A global funding mechanism whose mandate specifically includes reproductive, maternal, newborn, and child health (RMNCH) would be crucial to mobilise needed resources. The options are to add RMNCH to the mandate of an existing mechanism, or to needed services, such as the emergency obstetric services recommended by WHO. 12
Background The Countdown to 2015 for Maternal, Newborn, and Child Survival initiative monitors co... more Background The Countdown to 2015 for Maternal, Newborn, and Child Survival initiative monitors coverage of priority interventions to achieve the Millennium Development Goals (MDG) for reduction of maternal and child mortality. We aimed to report on 68 countries which have 97% of maternal and child deaths worldwide, and on 22 interventions that have been proven to improve maternal, newborn, and child survival. Methods We selected countries with high rates of maternal and child deaths, and interventions with the most potential to avert such deaths. We analysed country-specifi c data for maternal and child mortality and coverage of selected interventions. We also tracked cause-of-death profi les; indicators of nutritional status; the presence of supportive policies; fi nancial fl ows to maternal, newborn, and child health; and equity in coverage of interventions. Findings Of the 68 priority countries, 16 were on track to meet MDG 4. Of these, seven had been on track in 2005 when the Countdown initiative was launched, three (including China) moved into the on-track category in 2008, and six were included in the Countdown process for the fi rst time in 2008. Trends in maternal mortality that would indicate progress towards MDG 5 were not available, but in most (56 of 68) countries, maternal mortality was high or very high. Coverage of diff erent interventions varied widely both between and within countries. Interventions that can be routinely scheduled, such as immunisation and antenatal care, had much higher coverage than those that rely on functional health systems and 24-hour availability of clinical services, such as skilled or emergency care at birth and care of ill newborn babies and children. Data for postnatal care were either unavailable or showed poor coverage in almost all 68 countries. The most rapid increases in coverage were seen for immunisation, which also received signifi cant investment during this period. Interpretation Rapid progress is possible, but much more can and must be done. Focused eff orts will be needed to improve coverage, especially for priorities such as contraceptive services, care in childbirth, postnatal care, and clinical case management of illnesses in newborn babies and children.
20 years ago the global health community came together to highlight the most striking inequity in... more 20 years ago the global health community came together to highlight the most striking inequity in public health: half a million women 99% of them in the developing world were dying every year in pregnancy and childbirth. High fertility inadequate and inaccessible health services and womens low status meant that women in the poorest regions of the world were 500 times more likely to die from pregnancy-related complications (one in 20 risk) than women in northern Europe (one in 10 000 risk). The global Safe Motherhood Initiative was launched to generate political will identify effective interventions and mobilise resources that would rectify this horrifying injustice. Today 20 years into the initiative maternal mortality has declined in some regions especially in middle-income countries in Latin America and northern Africa as documented by Ken Hill and colleagues in todays Lancet. But dismally we are nowhere near the goals of reduction of global maternal mortality by 50% (the target setin 1987) or 75% (the target set by Millennium Development Goal [MDG] 5 accepted by the UN and heads of state in 2000). Progress has been achieved in other areas including much greater awareness of the issue and an enormous increase in knowledge about what works and what does not. But without substantial decreases in maternal mortality what is there to celebrate in 2007? As the 20th anniversary approached this dilemma was faced by the agencies organisations donors and individuals who helped launch the initiative. (excerpt)
The decisions by Ortho Pharmaceutical in 1985 to suspend manufacture and sale of the Lippes Loop ... more The decisions by Ortho Pharmaceutical in 1985 to suspend manufacture and sale of the Lippes Loop IUD and by G.D. Searle and Co. to suspend sales of the copper 7 and copper T 200 IUDs in the US have virtually eliminated the IUD as a potential contraceptive method for American women. The only remaining IUD on the US market is the little used Progestasert hormone-releasing IUD, which accounted for only 3% of the US market at the time of Searle's decision. The decisions were made as a direct result of the liability insurance crisis and the high cost of lawsuits in the US. The US legal system, unlike those of many countries, permits individuals who believe they have been injured by actions, inactions, or products of individuals, companies, or governmental organizations to sue. The number of such lawsuits rose by 680% in US federal courts between 1974-84, and the average damages awarded now exceed US $1 million. The phenomenon of joint responsibility, in which the plaintiff can sue all parties who can be defined as having had responsibility for the alleged injury, is particularly worrisome for industry. In practice this often means that plaintiffs concentrate their efforts on the party able to pay the greatest amount in damages. As the volume of lawsuits and damages awarded have skyrocketed, so has the cost of liability insurance. Some insurance companies simply refuse to insure high risk ventures at any price. Causes of the insurance crisis in the US are multiple, but one important factor is the new unwillingness of much of the public to accept any risks in return for benefits such as control of fertility. The Lippes loop has been the object of about 200 lawsuits and the Searle IUDs of about 800, 400 of which have been dismissed or settled out of court. Of those going to court, Searle won 9 and lost 2. Legal fees in 4 recent cases won by Searle exceeded $1.5 million. Alza Corp., manufacturer of the Progestasert, is now making the device available to all physicians requesting it, but Alza urges physicians to obtain informed consent and includes a 7-page pamphlet with each device. Each unit costs $84 compared to the $25 or so for copper IUDs, and each must be replaced annually. Many satisfied users and family planning personnel in the US are dismayed by the disappearance of an effective method from the market. Although there is no objective reason for the termination of IUD use in the US to affect the availability of IUDs in other countries, the continued distribution of IUDs elsewhere has aroused suspicion. The International Planned Parenthood Federation, Family Health International, other family planning organizations, and the US Agency for International Development have examined the records of the IUD and have reiterated their conviction that the method is safe and effective for appropriately selected users. They emphasize that the IUD has the unqualified approval of the US Food and Drug Administration.
International Journal of Gynecology & Obstetrics, 2013
New global guidance has emerged to support countries as they consider introducing or scaling-up m... more New global guidance has emerged to support countries as they consider introducing or scaling-up misoprostol for postpartum hemorrhage (PPH). The World Health Organization (WHO) and the International Federation of Gynecology and Obstetrics (FIGO) recognize the critical role that community and lay health workers play in preventing PPH and increasing access to misoprostol where skilled birth attendants are not available. As case examples from Nigeria and Nepal illustrate, community engagement and empowerment are critical strategies in successful misoprostol for PPH programs, and must increasingly be viewed as part of efforts to improve maternal health and achieve Millennium Development Goal 5.
International Journal of Gynecology & Obstetrics, 2011
Clinical and operational evidence indicates that misoprostol is a safe and effective technology f... more Clinical and operational evidence indicates that misoprostol is a safe and effective technology for addressing postpartum hemorrhage, a major cause of maternal death. This research has not yet been translated into effective policies, programs, and practice in many parts of the world. Efforts to expand evidence-based use of misoprostol are often complicated by misoprostol's range of indications, insufficient availability, a lack of evidence-based guidelines and provider training, and misconceptions about the drug. The medical and health policy communities need to work together to translate research findings into changes in policy, knowledge, and clinical practice so that we can deliver on the world's promise to improve maternal health.
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