After working in Nigeria for several years, where women have a 1 in 23 lifetime risk of dying from maternal causes, we are elated to report that we have accomplished our goal of making life-saving tablets, misoprostol, available to traditional midwives and mothers who are most at risk of dying of excessive bleeding or postpartum hemorrhage (PPH).  This summary will serve as our final project report.

VSI galvanized local leaders and organizations around the need for sustainable improvements in maternal health.  VSI collaborated with numerous partners in Nigeria to:

• Provide programmatic, technical and financial support to local implementing partners to raise awareness on the role of misoprostol to curb maternal mortality;
• Conduct community-level research to demonstrate that traditional birth attendants can safely administer misoprostol in the home, where many births take place;
• Demonstrate the safety of distributing tablets directly to pregnant women by community drug keepers;
• Provide technical assistance to multiple distributors for the registration of misoprostol for PPH;
• Involve the private sector to get misoprostol into rural markets for treatment of PPH;
• Create and distribute informational and educational materials in local languages on misoprostol;
• Assist the development of misoprostol clinical guidelines for Nigerian physicians and nurses;
• Coordinate over 50 community meetings to spread the news of this life-saving tablet;  
• Train over 12,000 providers - pharmacists, physicians, nurses, midwives and traditional birth attendants - on the use and benefits of misoprostol; and
• Facilitate the purchase and distribution of over 1,000,000 misoprostol tablets.

Our project also generated needed evidence to inform national policy.  In 2006, Nigeria became the first country in the world to approve and register misoprostol tablets for the prevention and treatment of postpartum hemorrhage.  The inclusion of misoprostol in the country's official clinical guidelines was a fundamental step towards ensuring its use at the facility level to control excessive bleeding after childbirth.  Last month, Nigeria had another monumental first.  Guidelines allowing misoprostol to be used at the community level were approved -- marking the first country to allow misoprostol to be used at the community level.  This accomplishment grew out of our active involvement and research, specifically a successful operations research project conducted by VSI and partners at Ahmadu Bello University in Zaria and the Bixby Center at UC Berkeley.

The success of our Nigerian project would not have been possible without the kindness, generosity and commitment of our Global Giving donors.  Your dedication to making maternal health an equal right no matter where women live helped us keep fighting for the reduction of unnecessary maternal deaths.  The impact of having misoprostol available on the village-level is literally saving lives and the Nigerian people are gracious and enthusiast about misoprostol life-saving effects.  Many mothers over the years have shared their stories and fears of bleeding to-death.   Now we have a “tablet that saves the lives of our mothers, sisters and wives” as one village elder shared with us.  Another village elder wrote a song about misoprostol impact in the community.

We encourage you to stay involved in our efforts to make childbirth safe for mothers in developing countries.  We hope you consider supporting our other Global Giving projects that work to prevent mothers dying in childbirth in Tanzania, Ethiopia and, coming soon to Global Giving, Mozambique.  We also invite you to stay in touch by visiting our website at www.vsinnovations.org and joining our email list.

Thank you again for helping us create sustainable change in Nigeria, enabling the government and other local NGOs to carry on supporting women with misoprostol in their country.  We could not have done it with you!

Links:

• VSI - Advancing Women's Health
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