Prevention of postpartum haemorrhage by community-based auxiliary midwives in hard-to-reach areas of Myanmar: a qualitative inquiry into acceptability and feasibility of task shiftingReportar como inadecuado

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BMC Pregnancy and Childbirth

, 17:146

Pregnancy and childbirth in low and middle income countries


BackgroundIn Myanmar, postpartum haemorrhage is the leading cause of maternal mortality and contributes to around 30% of all maternal deaths. The World Health Organization recommends training and supporting auxiliary midwives to administer oral misoprostol for prevention of postpartum haemorrhage in resource-limited settings. However, use of misoprostol by auxiliary midwives has not formally been approved in Myanmar. Our study aimed to explore community and provider perspectives on the roles of auxiliary midwives and community-level provision of oral misoprostol by auxiliary midwives.

MethodsA qualitative inquiry was conducted in Ngape Township, Myanmar. A total of 15 focus group discussions with midwives, auxiliary midwives, community members and mothers with children under the age of three were conducted. Ten key informant interviews were performed with national, district and township level health planners and implementers of maternal and child health services. All audio recordings were transcribed verbatim in Myanmar language. Transcripts of focus group discussions were fully translated into English before coding, while key informants’ data were coded in Myanmar language. Thematic analysis was done using ATLAS.ti software.

ResultsHome births are common and auxiliary midwives were perceived as an essential care provider during childbirth in hard-to-reach areas. Main reasons provided were that auxiliary midwives are more accessible than midwives, live in the hard-to-reach areas, and are integrated in the community and well connected with midwives. Auxiliary midwives generally reported that their training involved instruction on active management of the third stage of labour, including use of misoprostol, but not all auxiliary midwives reported using misoprostol in practice. Supportive reasons for task-shifting administration of oral misoprostol to auxiliary midwives included discussions around the good relationship and trust between auxiliary midwives and midwives, whereby midwives felt confident distributing misoprostol to auxiliary midwives. However, the lack of clear government-level written permission to distribute the drug was perceived as a barrier to task shifting.

ConclusionThis study highlights the acceptability of misoprostol use by auxiliary midwives to prevent postpartum haemorrhage, and findings suggest that it should be considered as a promising intervention for task shifting in Myanmar.

KeywordsMaternal health Community-based care Oral misoprostol Postpartum haemorrhage Auxiliary midwives Task shifting Qualitative inquiry Myanmar Abbreviations3MDGThe Three Millennium Development Goal Fund

AMWAuxiliary midwife

COREQThe consolidated criteria for reporting qualitative research

FGDFocus group discussion

IDIIn-depth interviews


WHOWorld Health Organization

Electronic supplementary materialThe online version of this article doi:10.1186-s12884-017-1324-6 contains supplementary material, which is available to authorized users.

Autor: Kyu Kyu Than - Yasmin Mohamed - Victoria Oliver - Theingi Myint - Thazin La - James G. Beeson - Stanley Luchters


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