Continuum of Care: Addressing Postpartum Hemorrhage in India and Nigeria

Investigator: Suellen Miller, PhD, CNM, MHA
Sponsor: Pathfinder International

Location(s): Nigeria; India


Second phase of the continuum of care project with the goal of contributing to the reduction of maternal mortality and morbidity due to PPH. The first phase of the project sought to prevent PPH, manage PPH when it occurred, and in more extreme cases, managed and treated shock (utilizing the non-pneumatic anti-shock garment [NASG]). The project extended from the community, where women are most likely to give birth at home or at the lowest levels of the health system, to higher level facilities where women can receive care for complications. In Nigeria, the project was implemented in 60 health facilities in seven states, and in India, the RAKSHA (Sanskrit for protection) project was implemented in 51 facilities in the state of Rajasthan.

In both Nigeria and India, the projects improved linkages from communities to facilities by supporting the establishment of community emergency transport systems and funds. These systems have been used to transport women to facilities for obstetric emergencies. Facility upgrades were also carried out to equip staff with delivery, surgical, and infection prevention materials, and in Nigeria, provision of alternate source of running water. Both countries observed improved facility readiness to provide emergency obstetric care and community awareness for birth preparedness. For example, the use of NASG for women in shock increased in both countries since project start, a testament to the improved ability of providers to recognize the signs of shock and apply the NASG. Pathfinder’s project in India focused on building partnerships, supporting and strengthening existing health systems, and promoting the presence of skilled birth providers during delivery at all levels to address and prevent PPH and pre-eclampsia.