Voices from the Field: 'The Life Of A Woman Does Not Have A Price,' Preventing Postpartum Hemorrhage in Mali

IntraHealth’s country director in Mali, Cheick Touré, recently presented the Minister of Health with the results of a study carried out by technical partners in collaboration with the Reproductive Health division of the Ministry of Health and regional and local MOH staff showing that matrones—auxiliary midwives who attend most births in Mali—can effectively perform active management of the third stage of labor (AMTSL). AMTSL is a WHO-recommended practice to reduce postpartum hemorrhage, the leading cause of maternal mortality. AMTSL also helps decrease other major complications that can occur during delivery, including retained placenta.

Touré shared findings from the pilot study, which compared matrones’ handling of AMTSL with skilled birth attendants currently authorized to perform the practice. After training, matrones were assessed on the skills and techniques involved in AMTSL and scored 96%, essentially the same as the skilled birth attendants’ score of 97%. Furthermore, matrones’ scores in recognizing and handling delivery complications were virtually identical to those of skilled birth attendants.

Impressed with the results, the Minister of Health, M. Oumar Ibrahim Touré, called for a swift response. “Should we authorize matrones to practice AMTSL? I will not hesitate—I authorize them to practice AMTSL. I would like to establish a commission to develop an action plan for training all matrones throughout the country. I would like the plan of action presented to me in two weeks.”

The study also assessed factors that could affect matrones’ ability to perform AMTSL. Oxytocin, a uterotonic drug that is a critical AMTSL component, was available at all the reference health centers in the study, as well as 13 of the 15 community health centers. Furthermore, oxytocin availability at nearby pharmacies and delivery rooms increased significantly during the study (doubling at the former and rising from 2 out of 18 to 10 out of 18 at the latter). Posters detailing AMTSL techniques were available in 15 out of 18 facilities. The number of AMTSL-trained health care professionals rose from 28% at the study’s baseline assessment to 91% at the study’s end.

By the end of the assessment, almost all vaginal deliveries in the study’s health facilities occurred using AMTSL. Many of these births were attended by matrones, and a significant decrease of the postpartum hemorrhage rate was noted between the baseline survey (1.9%) and the final assessment (0.13%). Between the two surveys an overall reduction of complications was observed (from 66 to 40), and no case of retained placenta or uterine rupture was reported.

As Professor Traoré Mamadou, Secretary General of the African Society of OB/GYNs, notes, “AMTSL is an intervention that makes a difference. We have ratified the joint statement of the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives so that all women who deliver in Mali can benefit from this practice. Authorizing the matrones to practice AMTSL would only be just, given the high number of deliveries they assist in Mali.”

“The life of a woman does not have a price,” sums up Dr. Konaté Lasséni, Secretary General of the Ministry of Health. “The department will do all that’s possible to protect against postpartum hemorrhage.”

The study on matrones represents a partnership among Mali’s Ministry of Health, National Department of Health/Division of Reproductive Health and several USAID-funded projects: the IntraHealth-led Capacity Project, the Prevention of Postpartum Hemorrhage Initiative (POPPHI) and the bilateral projects of USAID/Mali: Abt Associates, Inc-led Assistance Technique Nationale and CARE’s Keneya Ciwara projects, both supported by IntraHealth. The POPPHI project is led by PATH and includes four partners: RTI International, EngenderHealth, FIGO, and ICM.

Related news: Preventing Pospartum Hemorrhage in Mali