Multi-country survey reveals significant gaps in **Oxytocin**, **Magnesium Sulfate**, and **Carbetocin** availability for PPH/HDP management
Background
Postpartum hemorrhage (PPH) and Hypertensive Disorders of Pregnancy (HDP) remain leading causes of maternal death globally, particularly in low- and middle-income countries. Despite updated WHO recommendations and the availability of evidence-based interventions like heat-stable carbetocin and tranexamic acid, implementation gaps persist. This multi-country assessment aimed to evaluate the uptake of these practices, adherence to updated WHO guidelines, and the private sector's role in PPH and HDP management, addressing a critical need for comparative data across regions.
Study Design
From January to May 2022, 35 countries across sub-Saharan Africa, South and Southeast Asia, and Latin America and the Caribbean were invited to participate in a survey on PPH and HDP management. Using purposive sampling, country-based focal persons assembled national expert teams from public and private sectors, covering health policy, education, procurement, logistics, and information systems. These teams provided consensus-based answers by reviewing national data and policy documents. The study team then developed composite scores for quantitative indicators and thematically analyzed qualitative data to assess the availability of key interventions like Oxytocin and Magnesium Sulfate.
Results
Thirty-one countries successfully completed the survey, revealing persistent gaps despite progress since 2012. Oxytocin was reported as regularly available in public facilities by 77% of countries and in private facilities by 84% of countries. Availability of Magnesium Sulfate was notably lower, reported in public facilities by only 58% of countries and in private facilities by 45% of countries. Implementation of specific interventions also varied significantly: > Umbilical vein injection of oxytocin for retained placenta was reported in just 13% of countries, highlighting a major gap in a crucial PPH management technique.Heat-stable carbetocin for PPH prevention, a newer WHO-recommended intervention, was reported in 45% of countries, indicating moderate but incomplete uptake. These findings underscore the uneven adoption of evidence-based practices and the need for targeted interventions to improve maternal health outcomes.
Key Findings
- Oxytocin was regularly available in public facilities in 77% of countries and private facilities in 84%.
- Magnesium Sulfate was available in public facilities in 58% of countries and private facilities in 45%.
- Umbilical vein injection of oxytocin for retained placenta was reported in only 13% of countries.
- Heat-stable carbetocin for PPH prevention was reported in 45% of countries.
Why It Matters
This multi-country assessment provides crucial insights for global health policy and program planning, highlighting where efforts must be intensified to reduce maternal mortality. Closing the implementation gap for essential PPH and HDP interventions, especially Magnesium Sulfate and heat-stable carbetocin, is paramount. The data reveals specific areas for advocacy, resource allocation, and training, particularly concerning the private sector's role and the adoption of less common but effective procedures like umbilical vein oxytocin. For clinicians and health systems, these findings underscore the urgent need to standardize access to life-saving medications and ensure adherence to WHO guidelines across all healthcare settings, especially in resource-limited regions.
maternal-health
postpartum-hemorrhage
hypertensive-disorders-of-pregnancy
global-health
health-policy
survey