Prevention of postpartum hemorrhage at home birth in Afghanistan

Harshadkumar Sanghvi, Nasratullah Ansari, Ndola J.V. Prata, Hannah Gibson, Aftab T. Ehsan, Jeffrey M. Smith

Research output: Contribution to journalArticlepeer-review

65 Scopus citations


Objective: To test the safety, acceptability, feasibility, and effectiveness of community-based education and distribution of misoprostol for prevention of postpartum hemorrhage at home birth in Afghanistan. Methods: A nonrandomized experimental control design in rural Afghanistan. Results: A total of 3187 women participated: 2039 in the intervention group and 1148 in the control group. Of the 1421 women in the intervention group who took misoprostol, 100% correctly took it after birth, including 20 women with twin pregnancies. Adverse effect rates were unexpectedly lower in the intervention group than in the comparison group. Among women in the intervention group, 92% said they would use misoprostol in their next pregnancy. In the intervention area where community-based distribution of misoprostol was introduced, near-universal uterotonic coverage (92%) was achieved compared with 25% coverage in the control areas. Conclusion: In Afghanistan, community-based education and distribution of misoprostol is safe, acceptable, feasible, and effective. This strategy should be considered for other countries where access to skilled attendance is limited.

Original languageEnglish (US)
Pages (from-to)276-281
Number of pages6
JournalInternational Journal of Gynecology and Obstetrics
Issue number3
StatePublished - Mar 2010
Externally publishedYes


  • Afghanistan
  • Community-based distribution
  • Maternal mortality
  • Misoprostol
  • Postpartum hemorrhage
  • Skilled attendance

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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