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Improved Obstetric Care in Benin Is Saving Women's Lives
FrontLines - November 2009
By Dr. André Yebadokpo and Suzanne Gold
Challenge
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Improved obstetric care is helping families in Benin, including the Gansey family shown here.
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For many women in Benin,
giving birth continues to be a
life-threatening event.
National figures indicate
that as many as 400 pregnant
women die for every 100,000
live births, a figure that may be
an underestimation. The 2008
Human Development Report
ranked Benin 163 out of 177
countries for maternal deaths.
Regional data indicate that
more than a third of maternal
deaths are due to post-partum
hemorrhage, an excessive
bleeding that may occur after
childbirth.
Innovative Response
USAID began to reverse
this trend through its
Integrated Family Health
Program, known by its French
acronym PISAF.
In 2004, Benin’s Ministry
of Health adopted a practice
promoted by USAID called
the active management of the
third stage of labor (AMTSL),
which reduces postpartum
hemorrhage. However, many
facilities struggled to put it
into practice.
To get back on track, PISAF
designed an “improvement
collaborative” to translate
policies into effective practice.
In collaboratives, different
levels of the health system work
together to rapidly improve
quality in a specific health care
area. Teams develop indicators
and a proposed set of practices,
test these new practices, and
then apply successful changes
on a larger scale.
In Benin, PISAF launched
a collaborative in 2008 to
improve maternal and newborn
care, with a focus on AMTSL.
The collaborative also included
essential newborn care and
infection prevention. In consultation
with the government
of Benin, PISAF targeted the
Zou and Collines departments
in south-central Benin, which
comprise nearly 20 percent of
the small coastal West African
country tucked between Nigeria
and Togo.
The initial phase encompassed
17 health facility sites
that are undergoing changes to
ensure that all facilities provide
the three components of
AMTSL: administering oxytocin,
a drug to control bleeding,
immediately after the birth of
the baby; careful traction of
the umbilical cord; and uterine
massage.
Results
Rapid progress in applying
the three elements of AMTSL
has had a significant impact
on maternal mortality.
As performance of all three
elements rose from 73 percent
to 98 percent in less than a
year—between May 2008 and
March 2009—the rate of postpartum
hemorrhage decreased
by 53 percent.
Due to the success of the
collaborative in reducing postpartum
hemorrhage in the
initial demonstration phase,
PISAF expanded to 22 new
sites in June. PISAF, implemented
by University Research
Co. (URC), also plans to
add interventions to prevent
eclampsia—dangerous and
sometimes fatal seizures and a
significant cause of maternal
mortality—at all 39 sites.
Alice Gansey, one of
the mothers who received
AMTSL at the Zogbodomey
Maternity Center in Zou, can
hold the proof of PISAF’s
success in her arms.
“My husband and I
expected the worst because
of our previous experience,”
she said. “But to our immense
relief, everything went well
and I hardly bled at all.”
Today, Gansey’s son,
Prince Evrard, is eight months
old and healthy.
“For my previous delivery
in the Bohicon maternity, I
went into labor at about 7:45
a.m., and already by 8:30
a.m. I had lost consciousness
due to a major hemorrhage,”
Gansey said. “The care given
at this facility was not able
to stop the hemorrhage, so
the midwife referred me to
the departmental hospital
in Abomey. I was in crisis
despite the intensive care
provided…at the departmental
hospital. Thank God, I
managed to survive.”
★
FrontLines is published
by the Bureau for Legislative and Public Affairs
U.S. Agency for International Development
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Material should be submitted
by mail to Editor, FrontLines, USAID,
RRB, Suite 6.10, Washington, DC 20523-6100;
by FAX to 202-216-3035; or by e-mail to frontlines@usaid.gov
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