New EU-AU partnership to save women bleeding to death during childbirth

Postpartum hemorrhage death largely ended in high-income settings

NEWS ANALYSIS  | RONALD MUSOKE | The European Union (EU) has partnered with the African Union (AU) to fund a new project to accelerate access to life-saving medicines by pregnant women in five African countries including; Uganda.

Each year, around the world, about 14 million women experience postpartum hemorrhage (PPH), resulting in 70,000 lives lost. The majority of these women reside in Africa where access to health systems that can consistently provide quality assured life-saving medicines is limited.

The project aims to reduce severe bleeding after child birth or postpartum hemorrhage management in each of the targeted countries through strengthened regional pooled procurement mechanisms for life-saving medicines, technical assistance, and knowledge sharing in the Global South. Other countries to benefit from the €20 million (Approx. Shs 83 billion) initiative are Cote d’ Ivoire, Madagascar, Nigeria, and Zambia. The project will eventually spread across Africa through regional policy dialogue.

The EU funding was announced on March 20 during a European Union-African Union high-level event on global health in Brussels, Belgium. EU Commissioner, Jutta Urpilainen, Dr. Philippe Duneton, the Unitaid Executive Director and Dr. Natalia Kanem, the UNFPA Executive Director signed the agreement for the joint venture, titled “Safe Birth Africa: Improving access to innovative life-saving commodities for sexual and reproductive health in Africa.”

The partnership combines the United Nations sexual and reproductive health agency’s (UNFPA), the global maternal health leadership and network of midwives saving lives, and Unitaid’s record of innovative solutions in treating major diseases in low- and middle-income countries.

The joint venture is part of the Team Europe Initiative on Sexual and Reproductive Health and Rights (TEI SRHR) in Africa, a partnership with the African Union and its Regional Economic Communities with the support of the European Union and 10 of its member States.

It aligns with the priority of the AU and the EU to improve maternal health; including the AU Africa Cares: better reproductive health for women, children and adolescents by 2030, the EU Global Health Strategy and the Global Roadmap to combat postpartum hemorrhage between 2020 and 2030.

Africa’s maternal mortality challenge

The World Health Organisation (WHO) says maternal mortality–defined as the death of a woman while pregnant or within 42 days of termination of a pregnancy from any cause related to or aggravated by pregnancy or its management, but not from accidental or incidental causes–has declined worldwide by more than a third over the past 20 years thanks to advancements in technology and care which has led to affordable quality healthcare services.

However, the UN agency says as many as 303,000 women continue to die around the world from complications related to pregnancy or child birth. The majority of these deaths occur in sub-Saharan Africa. Women in sub-Saharan Africa suffer from the highest maternal mortality rate: 533 maternal deaths per 100,000 live births or 200,000 maternal deaths a year. According to WHO, the likelihood of a woman dying of pregnancy-related causes is about 1 in 37 in Africa.

Experts say maternal death figures may be inaccurate due to deaths that occur in lower-level facilities and outside hospital settings going unrecorded, incomplete or mis-classified. Many women who experience maternal deaths in sub-Saharan Africa live in poverty and do not receive adequate care in time to address complications. But the main complication that accounts for nearly 75% of all maternal deaths is severe bleeding after child birth or postpartum hemorrhage.

The UN’s World Health Organisation (WHO) has flagged it as the leading cause of maternal mortality worldwide, with stark disparities in survival rates between women in high- versus lower-income countries.

The WHO recommends a number of important interventions that, if appropriately deployed, are transformational for pregnant women in low- and middle-income countries. But the medicines needed for these interventions – drugs such as heat-stable carbetocin and tranexamic acid that can prevent and stop blood-loss – suffer from access barriers that prevent broader use.

The two entities, UNFPA and Unitaid will work with health authorities in five African countries as well as partners and communities to overcome barriers that limit access to life-saving solutions and medicines that are widely used in wealthy countries to prevent women from dying from child-birth related causes.

Unitaid will lead efforts to address the demand, cost, quality, supply and optimal use of three life-saving medicines, including through regional production of products, while UNFPA will focus on strengthening national level capacity, notably the capacity of midwives, to scale up tools and interventions for managing postpartum hemorrhage in line with the latest WHO guidelines.

“Every woman has the right to give birth safely,” said Dr Natalia Kanem, the Executive Director of UNFPA during the launch of the initiative. “By combining the expertise of UNFPA and Unitaid, and teaming up with health authorities across Africa, we will be able to accelerate women’s access to innovative maternal health care that improves health outcomes and saves lives.”

Unitaid’s efforts under this new funding arrangement will build on an existing US$45 million of investment to increase access to lifesaving products that prevent and treat postpartum hemorrhage and complements UNFPA’s Maternal and Newborn Health Thematic Fund which to date has supported training of more than 350,000 midwives.

“We have largely succeeded in ending postpartum hemorrhage death in high-income settings, yet women in resource-limited areas continue to die at unacceptable rates because effective medicines are inaccessible,” said Dr. Philippe Duneton, the Executive Director of Unitaid.

“But products alone cannot solve the problem without a health system that is primed for implementation. That’s why Unitaid is delighted to partner with the UNFPA, the UN sexual and reproductive health agency to ensure that our efforts to enable greater affordability and accessibility of tools quickly translate into widespread uptake and, ultimately, safer births.”

Going forward, the evidence generated through these collective efforts in the five countries will create models of care that can be disseminated to other countries and drive down the risk of death in childbirth across Africa and beyond.