Expanding uterotonic protection following childbirth through community-based distribution of misoprostol: operations research study in Nepal

Int J Gynaecol Obstet. 2010 Mar;108(3):282-8. doi: 10.1016/j.ijgo.2009.11.006. Epub 2010 Jan 19.


Objective: To determine feasibility of community-based distribution of misoprostol for preventing postpartum hemorrhage (PPH) to pregnant woman through community volunteers working under government health services.

Methods: Implemented in one district in Nepal. The primary measure of performance was uterotonic protection after childbirth, measured using pre- and postintervention surveys (28 clusters, each with 30 households). Maternal deaths were ascertained through systematic health facility and community-based surveillance; causes of death were assigned based on verbal autopsy.

Results: Of 840 postintervention survey respondents, 73.2% received misoprostol. The standardized proportion of vaginal deliveries protected by a uterotonic rose from 11.6% to 74.2%. Those experiencing the largest gains were the poor, the illiterate, and those living in remote areas.

Conclusion: Community-based distribution of misoprostol for PPH prevention can be successfully implemented under government health services in a low-resource, geographically challenging setting, resulting in much increased population-level protection against PPH, with particularly large gains among the disadvantaged.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Community Health Workers*
  • Delivery of Health Care
  • Delivery, Obstetric / statistics & numerical data
  • Feasibility Studies
  • Female
  • Home Childbirth*
  • Humans
  • Misoprostol / therapeutic use*
  • Nepal
  • Operations Research
  • Oxytocics / therapeutic use*
  • Patient Acceptance of Health Care
  • Postpartum Hemorrhage / prevention & control*
  • Pregnancy
  • Self Administration


  • Oxytocics
  • Misoprostol