Uterotonic Use in the Third Stage of Labor: New Methodology for Estimating National Coverage

This critical practice should be carried out either as part of active management of the third stage of labor (AMTSL) for women who deliver in a facility, or as a single intervention for women who deliver at home. Three uterotonic drugs are generally accepted as effective uterotonics: oxytocin, misoprostol, or ergometrine, with oxytocin being the drug of choice according to global recommendations. Despite the widely accepted standard of care in PPH prevention, few countries currently have data on the percentage of births in the country protected from PPH through use of a uterotonic. In an effort to assist countries to meet the World Health Organization's (WHO) recommendation to monitor the use of uterotonics after birth for the prevention of PPH, the Maternal and Child Health Integrated Program (MCHIP) has piloted a rapid estimation exercise for the measurement of use of a uterotonic in the third stage of labor (UUTSL). The methodology, piloted in Mozambique, Tanzania, and Jharkhand State, India, will allow countries to track progress toward reduction in PPH, and thus, prevention of maternal mortality. The estimation methodology developed by MCHIP is based on the distribution of place of birth, the likelihood of uterotonic use in those various settings, and the availability of uterotonics. Existing data on these elements are gathered and experts come together in a brief meeting where they review and validate the available data, provide estimates where there are no data, and then use these inputs to calculate an estimate for UUTSL across all births – both facility- and community-based. The methodology involves a preparatory phase, an expert panel meeting, and a review of the estimate and development of recommendations to address coverage gaps. The methodology was applied in May and June of 2013 in Mozambique, Tanzania, and Jharkhand State, India. The results of the estimation exercises showed that the uterotonic use in the third stage of labor was very similar in all three settings, with estimates ranging from 40% to 44%. The process highlighted gaps in coverage at the community level and the need for more targeted programs. It also raised issues of uterotonic availability and quality, and potential policies and practices that inhibit high coverage. Finally, this exercise underscored the need to improve data gathering and data quality for UUTSL, both at the facility and household level. The goal of this exercise was to have policy makers, health care managers, and other stakeholders develop estimates for UUTSL coverage in their countries that they could then use as a reference point for strengthening the programs which make uterotonic drugs available to all women who give birth. The process highlighted the importance of improving data gathering and data quality for UUTSL, both at the facility and household level. MCHIP, with the support of USAID, continues to work with countries to improve programs, seek innovative solutions to persistent problems, and monitor progress toward universal UUTSL coverage.