Preventing Postpartum Hemorrhage In Mali—Building On Success

Postpartum hemorrhage (PPH) is the leading cause of maternal deaths in developing countries such as Mali1. Through projects funded by USAID, IntraHealth and partners2 are working to prevent PPH—and save women’s lives—by increasing access to active management of the third stage of labor (AMTSL), a proven practice for reducing PPH. 3

Beginning in 2002, the IntraHealth-led PRIME II Project showed that AMTSL could be successful in Mali’s service delivery system: the number of PPH cases among women giving birth vaginally dropped by 48% in the facilities where AMTSL was introduced. Women who gave birth with AMTSL found the length of the third stage of labor reduced, interactions with health care providers enhanced and postpartum monitoring improved. Health care providers indicated that the practice not only helped them decrease hemorrhage and delivery time for their patients, but also alleviated their own anxieties about PPH during deliveries.

At first only doctors in Mali were authorized to administer AMTSL. Through PRIME II’s work, nurses and midwives became included in AMTSL training. By the end of the project 84 doctors, nurses and midwives had been trained in providing AMTSL and in training others to perform this technique. However, most Malian women don’t give birth under the care of doctors, nurses, or midwives, but with a cadre of skilled birth attendants called matrones that were not sanctioned by the government to provide AMTSL.

The Capacity Project is working with the Mali Ministry of Health, USAID’s Prevention of Postpartum Hemorrhage Initiative (POPPHI, led by the Program for Appropriate Technology in Health), the ATN Project (led by Abt), and Keneya Ciwara Project (led by CARE) on plans to expand AMTSL in other districts—Koulikoro, Sikasso and Gao—to demonstrate that they can be successfully trained and authorized to perform AMTSL. The project has supported the training of 57 matrones in AMTSL administration as well as 60 drug managers in proper storage for AMTSL medications. In the locations covered by these health care workers the percentage of women who received AMTSL during labor increased from 35% to 92% between December 2006 and January 2007. The Capacity Project is working with the Mali Ministry of Health, USAID’s Prevention of Postpartum Hemorrhage Intiative (POPPHI), and other international organizations on plans to expand AMTSL in other districts.

Through PRIME II, IntraHealth also supported the introduction of AMTSL in Benin and Ethiopia, with reductions in PPH similar to those in Mali. In addition, IntraHealth currently promotes AMTSL in Senegal, through our Maternal, Neonatal, and Child Health/Family Planning/Malaria Project.

1Khan Khalid S, Wojdyla Daniel, Say Lale, Gülmezoglu A Metin, and Van Look Paul FA, WHO analysis of causes of maternal death: a systematic review, The Lancet, 367, no. 9516, (April 2006): 1066-1074. 

2IntraHealth’s PRIME II partners were: Abt Associates, EngenderHealth, the Program for Appropriate Technology in Health (PATH), the Training Resource Group (TRG), the American College of Nurse Midwives (ACNM) and Save the Children. In Mali the Capacity Project partners with Liverpool Associates in Tropical Health. IntraHealth also works with Assistance Technique Nationale (led by Abt Associates) and Keneya Ciwara (led by CARE).
3Further information about AMTSL: The third stage of labor is the period between the birth of the infant and the delivery of the placenta. Active management of this period involves a combination of drugs and physical aid to deliver the placenta. By shortening the time between childbirth and placental delivery, AMTSL reduces the mother’s blood loss. When excessive bleeding does occur it can be quickly identified and treated.