Saving Women During Childbirth Starts in a Surprising Place: The Refrigerator

We have medicine to prevent hemorrhage after childbirth, but it is not reaching women in developing countries. Expert Beth Yeager discusses how we can make sure this lifesaving technology is available to those who need it.

Although we now have the technology to launch an electric car into space using reusable booster rockets, and, to give a more mundane example, can communicate via video conference with people all over the globe on a daily basis, something as commonplace as childbirth is still one of the riskiest moments in a woman’s life, especially for women in low- and middle-income countries.

According to the WHO, “a woman’s lifetime risk of maternal death — the probability that a 15-year-old woman will eventually die from a maternal cause — is 1 in 4,900 in developed countries, versus 1 in 180 in developing countries. In countries designated as fragile states, the risk is 1 in 54; showing the consequences from breakdowns in health systems.” One of major causes of these deaths is postpartum hemorrhage — excessive bleeding after childbirth.

That’s the bad news. The good news is we do have the technology to prevent these deaths: a medicine that has been in use for over one hundred years — oxytocin.

Yet, one of the breakdowns in health systems that contributes to maternal deaths is that quality-assured oxytocin is often unavailable when and where women need it. Oxytocin is a heat-sensitive product that requires transportation and storage in the cold chain. Storage at room temperature or higher can result in product degradation, especially in areas with tropical climates. While the risks associated with exposure to room temperatures or higher are well known, oxytocin is still not appropriately stored during distribution, in warehouses, and at health centers and hospitals.

In an effort to tackle this issue and increase availability of quality oxytocin, the Global Health Supply Chain Program — Procurement and Supply Management (GHSC-PSM) project, in collaboration with the Maternal Health Supplies Caucus of the Reproductive Health Supplies Coalition and PATH, brought together a diverse coalition of medicine manufacturers, national governments, universities, non-governmental organizations, and global health practitioners in October of last year to review current evidence around oxytocin and come up with evidence-based, actionable recommendations. Following two days of intense review of state-of-the-art technical information on the current state of oxytocin management, the key recommendations that the participants agreed on can be summarized as “buy good stuff and keep it cold!” In more formal terms:

Procure only oxytocin which is quality-assured and labeled for storage between 2 and 8 degrees C, as inconsistent labelling has led to confusion around storage temperature requirements for oxytocin.
Always store oxytocin between 2 and 8 degrees C, even if the label indicates it can be kept at higher temperatures.
Where possible, integrate oxytocin storage and distribution into existing cold chains, such as those for vaccines.

GHSC-PSM is continuing to work with the Reproductive Health Supplies Caucus and other stakeholders to promote these recommendations and, more importantly, to assist countries in their operationalization. This is the challenging part because it means thinking through the supply systems implications. What policies may need to change? What personnel throughout the health system will need to be informed and what are we asking them to do differently? What changes in information systems may be necessary? What investment will operationalization of these recommendations require and where will the funds come from? Countries will need to answer these questions and others to make sure quality oxytocin is available throughout the health system.

Despite these challenges, we know what to do and we have the technology. We just need to figure out how to do it efficiently and effectively so that no woman needs to worry about dying when giving life.