Postpartum hemorrhage (PPH) is a major cause of maternal death and accounts for more than one quarter of all such deaths in low-resource regions of the world. Since 2004, Gynuity Health Projects has been collaborating with partners to conduct clinical and programmatic research, generate and synthesize evidence to inform policy and practice, and provide technical assistance to governments and other key stakeholders in order to address gaps in PPH care. We focus especially on developing and translating the scientific evidence on misoprostol into effective policies, programs and practices for PPH prevention and treatment.
Gynuity assesses technologies, in particular misoprostol, and interventions that are appropriate for PPH care in low-resource environments and community settings. We design and evaluate service delivery and program approaches to: a) improve the availability and use of low cost technologies for the management of PPH; and b) facilitate timely and effective PPH treatment options across multiple levels of care.
Training and Education
Gynuity’s training efforts focus on supporting the introduction of technologies and interventions that are appropriate and useful for PPH at all levels of care. We develop training modules that summarize the latest evidence-based findings on misoprostol and other technologies for PPH management as well as monitoring tools geared towards different levels of providers and low literacy audiences. In addition to collaborating with partner agencies on national training programs, we organize technical consultations to guide national health care programs and service delivery organizations seeking to incorporate misoprostol for PPH indications into their programs of work.
Gynuity provides technical assistance to agencies and governments to increase their knowledge of research findings on misoprostol for PPH, develop misoprostol-focused programs for implementation, and prepare monitoring and evaluation components to their programs. Our efforts in this area support the integration of evidence-based practices for PPH management and the inclusion of misoprostol for PPH into national essential drugs lists, service delivery guidelines, and training curricula.
Policy and Advocacy
Gynuity works closely with international and regional partners --including FIGO, WHO and the FCI Program of Management Sciences for Health-- to advance better understanding, use and acceptance of misoprostol for PPH through advocacy and policy change. Evidence generated through our research helps inform the advocacy agenda. We pursue policy change by preparing and submitting applications for misoprostol for PPH to be included on the World Health Organization’s Model List of Essential Medicines (WHO EML), and advocating for its inclusion to national-level essential drugs lists, country-level norms and clinical guidelines. We collaborate with pharmaceutical companies to push for greater availability of quality misoprostol products for PPH.
Key milestones clarifying the role of misoprostol for PPH indications
Misoprostol added to the WHO EML for the prevention of PPH (2011) and treatment of PPH (2015).
Joint statement issued by the International Confederation of Midwives (ICM) and the International Federation of Gynecology and Obstetrics (FIGO) recommending misoprostol for the treatment of PPH in low resource settings (2014).
European Medicines Agency approved the first misoprostol product, Hemoprostol, for the treatment of PPH (2014).
International guidelines issued by WHO and FIGO recommending misoprostol for the prevention and treatment of PPH (2012).
To address issues of access of misoprostol for PPH care from all perspectives, Gynuity develops informational and educational materials in multiple languages for use by a range of audiences. In addition to publishing study results in peer-reviewed scientific journals, we synthesize evidence into user-friendly formats to highlight evidence-based research findings that inform policymakers and program implementers and that assist organizations and health facilities to educate providers, families and women on how to use misoprostol for PPH care. The materials include an Instructions for Use brochure series that outlines regimen options for the prevention and treatment of PPH using misoprostol and pamphlets that contain pictorial panels targeted to an illiterate or low literate audience. We create short films to highlight the programmatic realities that exist in many settings as well as showcase the different service delivery models for PPH in our studies.
Providing guidance to others in their efforts to improve maternal & neonatal health