1. Qualitative Insights Regarding Use of Misoprostol for PPH Prevention in Rural Zambia

2.  Maternal Mortality Ratio: 591/100,000 live births  Post Partum Haemorrhage is the commonest cause; 34%  94% pregnant women received antenatal care  52% of all births occur at home Source: ZDHS 2007 Zambia context

3.  In-depth interviews, December 2009  28 women aged 18-49 who received Misoprostol from antenatal provider or a TBA and subsequently delivered  22 women who used Misoprostol following a delivery at home  6 women who used Misoprostol following delivery at a health facility — due to insufficient access to Oxytocin  6 women who assisted deliveries following which Misoprostol was used  Chongwe, Lufwanyama & Mwense districts Methodology

4. To what extent are key messages being passed onto pregnant women during antenatal care What happens after a woman leaves a facility with her misoprostol tablets in hand—does she talk with anyone about the drug, how does she store it, and does it influence her decisions about where to deliver? Key issues addressed

5. What are the experiences and perceptions of women who have taken misoprostol following home delivery, compared to their perceptions of previous home deliveries. Would they recommend this drug to a friend or neighbor? Key issues addressed…

6. Women showed understanding of: - the purpose of misoprostol - when to take the drug (after the delivery of the baby) -Precautions (ensuring that the woman is checked for a second baby before she swallows misoprostol) -Common side effects After collecting misoprostol during ANC, women discuss misoprostol with: - Spouses, friends, relatives or no one at all Outcomes

7. Women showed understanding of the need for good storage & ensured that they follow the storage instructions for misoprostol Storage of Misoprostol

8. There is general appreciation of misoprostol Although, some feel it might negatively affect fertility & fetal development of future pregnancies, etc Community-Level Myths

9. Though the women delivered from home, having Misoprostol was not cited as a reason why they opted to deliver from home. They could have managed to go to the facility but there were other extenuating factors. Effect of Misoprostol on Delivery Plans

10. Future PPH prevention programs in similar rural settings should consider:  Antenatal distribution of Misoprostol in areas with high rates of home deliveries and/or limited access to skilled providers & supplies.  Addressing community level myths/misconceptions  Providing additional guidance regarding the timing and sequence for correct use of Misoprostol to prevent PPH.  Continuing efforts to promote Misoprostol within the context of broader safe delivery programming. Findings Suggest that…

11. Thank You