Why medicine quality matters for maternal health
Maternal Health Poor quality of maternal health medicines contributes to maternal deaths and is holding countries back from achieving development targets. Governments need to take decisive action.
While many countries are struggling to reduce maternal mortality to the global target of 70 deaths per 100,000 births, countries like Finland have demonstrated that only in exceptional circumstances should we accept a woman dying while giving birth. Finland's maternal mortality ratio is just three deaths per 100,000 births.
One reason countries continue to struggle to reduce maternal deaths is the extraordinarily high prevalence of poor quality medicines.
The World HealthOrganization (WHO) recommends that every woman receives uterotonics following childbirth to prevent postpartum haemorrhage, all of which can be of poor quality by the time they reach the patient if not manufactured, packaged, transport- ed and stored properly.
Magnesium sulfate - a drug used to prevent and treat pre-eclampsia - is a simple, cheap, effective life-saving drug if the quality is right. However, many women lack access to these safe, effective drugs and die as a result.
In the two countries with the highest number of maternal deaths annually, recent studies revealed unacceptably high levels of poor quality maternal health medicines.
In 2017, the Government of India published a nation-wide survey of the quality of medicines in which oxytocin was identified as one of the most frequently out-of-specification medicines. 41.3% of the samples tested were out of specification. Even more alarming are the survey results for the same drug in Nigeria where a staggering 74.2% of oxytocin samples failed testing standards. This study has sparked a number of actions within the Ministry of Health and the National Agency for Food and Drug Administration and Control in Nigeria.
At a recent event in Geneva on incentivising investment in quality medicines, NAFDAC’s recently appointed Director General, Professor Adeyeye, talked of her own personal childbirth experience where the drugs used to induce her labour failed to work. After a prolonged labour, an emergency caesarean section was performed to save hers and her baby’s lives. She also talked of her older sister who died of haemorrhage following childbirth. The poor quality of the medicines is likely to have played a significant role in both of these events. In fact, it is a practice that doctors administer higher doses to effectively induce labor. Professor Adeyeye now uses the experience to energise her mission to drastically improve the quality of medicines in the country.
What can countries do to improve the quality of maternal health medicines?
Lester Chinery is the Director of Operations at Concept Foundation. Chinery points out that regulatory control plays a strong role in ensuring that the medicines available in countries are of suitable quality. In Nigeria, where the majority of maternal health medicines are imported, NAFDAC Director General Professor Adeyeye has sought and won long barred access to the ports to ensure that the medicines entering the country are registered and of appropriate quality. Other countries are working in partnerships such as the EAC/SwissMedic Marketing Authorisation for Global Health Products programme to strengthen the capacity of their regulatory authorities.
High-quality maternal health medicines are available for under $1 - a small price to save a woman's life.
Improving procurement practices is another critical area where countries can improve the quality of maternal health medicines. Policies must ensure that only quality assured medicines are procured in order to bring down maternal mortality. Price is too often the only procurement criteria and one that ignores the full costs associated with medicine failure such as unnecessary surgery and the high financial burden of maternal death.
Countries also need to prioritise investments in appropriate storage and transport of medicines, according to Chinery. Many maternal health medicines require cold chain from manufacturer to user. Where this cannot be assured, countries need to look to genuine heat-stable alternatives.
The #MedsWeCanTrust campaign
#MedsWeCanTrust is a global campaign to drive countries to prioritise access to safe, quality medicines, bringing together political leaders, health advocates, researchers and journalists to create a sense of urgency and ensure action. The campaign will be calling on governments to take action on the quality of all medicines, including those that are essential for maternal health and safe childbirth.
It’s time for countries to make a real commitment to ensuring access to quality maternal health medicines.
Join the #MedsWeCanTrust campaign at medswecantrust.org
Concept Foundation is an NGO working with governments, manufacturers and global health stakeholders to improve access to quality reproductive and maternal health medicines.
Concept Foundation is supported by funding from MSD, through MSD for Mothers, a 10-year $500 million initiative to help create a world where no woman dies giving life. MSD for Mothers is an initiative of Merck and Co. Inc., Kenilworth, NJ, USA.