India
In India, fewer than 50% of women have a skilled attendant at birth; the maternal mortality ratio is 450 (450 women die for every 100,000 live births), and a lifetime risk of maternal death of 1 in 70 (UNICEF, 2009).
In a country as populous as India, this is a loss of 125,000 girls and women every year.
UCSF's Safe Motherhood Program in collaboration with University of Illinois, Chicago, Gynuity Heath Projects, New York, JN Medical College (JNMC), Belgaum, India and BLDEA University’s Sri B. M. Patil Medical College (BMPMC), Bijapur, India are conducting a large, 3000 woman, randomized cluster trial of two strategies of using misoprostol for preventing PPH at the community level. Auxiliary Nurse Midwives who attend birth at the home or subcenter level are randomized to either a primary prevention or a secondary prevention arm. Acceptability, ease of use, and maternal outcomes will be compared between the two strategies.
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(above) Dr Miller with the Bijapur team were featured in the local newspaper marking the trial beginning
Additionally, Dr. Miller has been collaborating with the NGO Pathfinder International and Dr. Stacey Geller of the University of Chicago, Illinois on a project aimed at reducing these deaths in India.
A Continuum of Care Project is underway which serves to reduce maternal deaths through educating the local community and birth assistants in methods to prevent complications of childbirth and early identification of problems; setting up of systems of communication, transport and referral for women who need to be treated at health care facilities, and ensuring adequate treatment is available at the health care facilities
The LifeWrap is an essential part of this continuum for women who suffer excessive bleeding and shock despite prevention and early recognition.
This implementation project is entering Year 3 in 3 states in India and is also in place in Nigeria. For more information please visit the Pathfinder website by clicking on their logo.
You can also read about the Continuum of Care in a publication co-authored by Dr. Miller: A Continuum of Care Model for Postpartum Hemorrhage in the International Journal of Fertility & Women's Medicine 52(2-3), 97-105, 2007.