As I have written many times before postpartum hemorrhage (PPH) or excessive uterine bleeding after childbirth is the leading cause of maternal mortality in low-and-middle income countries. The recommended drug to prevent PPH according to the World Health Organization (WHO) is oxytocin. When administered in its recommended dose it causes little to no side effects. Oxytocin, the WHO’s current gold standard therapy, however, must be refrigerated and administered by skilled health workers posing two obstacles to its wider use in low resource, tropical settings.
Some countries have approved misoprostol, an oral drug, to prevent PPH, but there are several concerns that its use can be misappropriated for abortions instead of used solely for PPH. The World Health Organization has listed misoprostol as an alternative to oxytocin if it is not available.
Now, another PPH preventative drug, carbetocin, has been added to the latest updated 2019 WHO Essential Medicines List. The announcement was made last week. Unlike oxytocin, even at high temperatures carbetocin remains effective. The recommendation is that carbetocin can be used when oxytocin is not available or if its quality is uncertain. Additionally, the cost must be comparable to oxytocin.
When people think about new inventions, 95% of them immediately begin thinking about tech inventions, but what about medical inventions that save lives? Merck recently launched a video that asked Americans what invention they are waiting for. Take a look. Did you know 68% of Americans cannot name a single scientist working to invent medicine? Merck has been working for over a century on medicines … Continue reading Featured Video: What Invention Are You Waiting For?
When everyday Americans think about women dying during childbirth it is probable that their initial thoughts travel directly to Africa where it is quite well known that maternal mortality is rife. Chances are their thoughts never focus on the deaths and near deaths during childbirth that women experience right here in the United States. After all, the overwhelming consensus is that the United States has the best medical care, superior health workers and health system in the world despite some of its inherent challenges. This thinking renders maternal mortality in the US thoroughly inconceivable to many even while data reveal it should not be inconceivable at all. In fact, maternal mortality is on the rise in America having doubled over the past 25 years all while global maternal deaths are steadily declining. Globally, maternal mortality was effectively reduced by 44 percent according to the World Health Organization.
The United States, while not the overall leader in maternal mortality among all countries, it is the leader among all developed nations. The United States ranked number 33 out of 179 countries in Save the Children’s 2015 Mothers’ Index Ranking and 46th in the world due to the rate of women who die from pregnancy and childbirth complications. Compared to other developed countries, the United States’ ranking is abysmal, especially with Norway, Finland, and Iceland ranking in the top three overall. Even countries like Estonia and Belarus, whose GDPs are considerably lower than ours, far outrank America.
Earlier this year I wrote about the important maternal mortality art work of Chicago-based artist and activist, Michelle Hartney and her plan to sew 1,200 hospital gowns for her performance art, MOTHER’S RIGHT — one for every woman who died in the US during childbirth in 2013. Hartney will perform this piece on September 7th at the Daley Center in Chicago at Improving Birth’s “Liberate Labor” rally. … Continue reading Instagram Photo About U.S. Maternal Mortality You Don’t Want to Miss
Throughout the summer we will speak with some of the most notable maternal health advocates in the world ahead of the Global Maternal Newborn Health Conference that will be held in Mexico City between October 18 – 21, 2015. Follow the conversation at #MHHSS. Read all of the interviews below.
Speaking with Dr. Priya Agrawal, Executive Director of Merck for Mothers, for this latest interview in our Maternal Health Heroes Summer Series, I instinctively realized that she is not only a gifted communicator with a passion for women’s health, but also an infectious advocate for safe motherhood both in the United States and worldwide.
Merck for Mothers, a 10-year, $500 million initiative aimed at reducing maternal mortality, was launched in 2011 and initially set robust goals to reduce women’s deaths during childbirth in low- and middle-income countries. Like many in America, Merck for Mothers failed to initially realize at the time that maternal mortality in the United States is a persistent problem that is steadily worsening. In fact, that line of thinking is quite understandable given most of the 800 women who die every day during childbirth live in sub-Saharan Africa and Southeast Asia.
The good news for women living in low- and middle-income countries, however, is maternal mortality has drastically been reduced by 45 percent since 1990, a marked change despite the future reductions that still need to occur during the Sustainable Development Goals era. Sadly, in the United States the numbers are not improving. “The United States is the forgotten child when it comes to maternal mortality,” Agrawal mentions. “We learned very quickly that even in our backyards we had to do something. Maternal mortality has more than doubled in the United States. The trend is going in the wrong direction.” Given the amount of money spent on health care in the United States, we experience the highest maternal mortality ratio than any other developed country in the world.
Without question, the highest rates of maternal mortality are found in sub-Saharan Africa. That certainly doesn’t mean that other regions do not also experience far too many maternal deaths. In Argentina, for example, there are 69 maternal deaths per 100,000 live births, Mexico’s MMR is 49 and Colombia’s is 83. To prevent those maternal deaths the Pan American Development Foundation (PADF) partnered with Merck to better learn the root causes of maternal mortality in the aforementioned three countries. Merck’s two-year, $500,000 grant will be used to bolster the data PADF finds and logs onto No Mas Huérfanos (No More Orphans).
Thus far, PADF has partnered with local organizations in each country and subsequently learned that maternal deaths were caused by a combination of factors including poverty, access to potable water, education, health care, and gender violence.
“A world in which mothers can see their children grow and enjoy their childhood is a real possibility if we achieve the prevention of the hundreds of deaths that occur after giving birth,” said Caterina Valero, PADF Senior Programs Director in a statement. “Beyond the loss for the child, the death of a mother leaves a legacy of death and poverty. Orphaned children are two times more likely to die before age two and ten times more likely to quit school. This perpetuates the cycle of poverty.”
The word is getting out that maternal and newborn mortality are an ever-increasing problem in the United States. As I have written before, the United States has the highest ratio of maternal mortality of any developed country in the world and yet we spend the most on health care globally.
While many (including scientists and health professionals) don’t know concretely why maternal mortality is continuing to rise in the US, the fact remains that the problem is not getting better. In fact, it is incrementally getting worse. In fact, according to recent findings from the Institute for Health Metrics and Evaluation the United States has a maternal mortality rate of 18.5 maternal deaths per 100,000 live births in the U.S., up from 12.4 deaths per 100,000 births in 1990.
Companies such as Merck that launched Merck for Mothers and Texts4Baby, for example, are working on innovative ways to reach and inform mothers about how they can be as healthy as possible during and after childbirth. Additionally, grassroots organizations and birthing centers like Florida’s CommonSense Childbirth and Arizona’s The Birthing Project are working in communities to help mothers and their newborns stay alive.
Merck for Mothers is a 10-year, $500 million global initiative that applies Merck’s scientific and business expertise to help reduce maternal mortality worldwide. So far, with our partners, they have helped an estimated 3.5 million women around the world including the United States. We agree, no woman should die giving life. Watch their #EndMaternalMortality video. Photo: Jennifer James Continue reading Featured Video: #EndMaternalMortality
Earlier this month I wrote about Uganda’s move to use misoprostol for women who experience postpartum hemorrhage (PPH) during childbirth or immediately after delivery. PPH is the leading cause of maternal mortality for women around the world. 800 women die every day from complications during pregnancy and delivery; that is two mothers a minute.
Misoprostol, it has been found, is effective because it will stop a woman’s bleeding, can be taken in pill form and can be stored at hotter temperatures. Oxytocin, which is the gold standard for stopping PPH must be stored in cold temperatures to be effective. However, in low-resource settings electricity can be touch and go or altogether nonexistent.
Last year Merck announced that they have partnered with the World Health Organization as well as Ferring Pharmaceuticals to test the efficacy in clinical trials of using carbetocin, another medication that can stop PPH, but can be stored in hot and tropical environments.
The clinical trials began this year in 12 countries that included 29,000 women. Through its Merck for Mothers initiative, Merck has partnered with organizations in the United States and abroad to reduce maternal mortality around the world.
Last week PSI released its latest issue of Impact magazine: The Best Buys Issue. For this issue of Impact, PSI partnered with Devex, Merck for Mothers and PATH to ask one key question: What are the best buys for global health and development? During a two-hour conversation held at the Center for Global Development global health experts and practitioners discussed the best places to invest in global … Continue reading 5 Best Buys for Improved Maternal Health
When we talk about sky-high maternal mortality rates we tend to look more closely at low-income countries like Afghanistan, Chad and Somalia that have the world’s highest maternal mortality rates in the world according to the World Bank. And, of course, sub-Saharan African countries need to desperately bring their numbers down. But when you look at rich, developed countries the United States has the highest … Continue reading Maternal Mortality in the US: The Numbers May Surprise You