Globally, more than 350 000 women die annually from complications during
pregnancy and childbirth (UNFPA, 2011). Nearly 99% of these, according to World
Health Organization (WHO) trends (2010) occur in the developing world outside of a
hospital setting with limited resources including emergency care (WHO, 2012; UNFPA,
2011). The most prevalent cause of death is postpartum hemorrhage (PPH), accounting
for 25% of deaths according to WHO statistics (2012). Conditions in Afghanistan are
reflective of the scope and magnitude of the problem. In Afghanistan, maternal mortality
is thought to be among the highest in the world. The Afghan Mortality Survey (AMS)
data implies that one Afghan woman dies about every 2 hours from pregnancy-related
causes (AMS, 2010). Lack of empowerment, education and access to health care
resources increase a woman's risk of dying during pregnancy (AMS, 2010). This project
aims to investigate the prospects of scaling-up the correct use of misoprostol, a
prostaglandin E1 analogue, to treat PPH in developing countries where skilled assistance
and resources are scant. As there has been little published on the lessons learned from
programs already in place, this study is experience-driven, based on the knowledge of
industry experts. This study employs a concurrent triangulation approach to synthesize
quantitative data obtained from previous studies with qualitative information gathered
through the testimonies of key personnel who participated in pilot programs involving
misoprostol. There are many obstacles to scaling-up training initiatives in Afghanistan
and other low-resource areas. The analysis concludes that the most crucial factors for
scaling-up community-based programs include: more studies analyzing lessons learns ii
from community driven approaches; stronger partnerships with community health care
workers; overcoming barriers like association with abortion, misuse and product issues;
and a heightened global and community awareness of the severity of PPH without
treatment. These results have implications for those who actively work in Afghanistan to
promote maternal health and other countries that may use Afghanistan's work as a
blueprint for reducing maternal mortality through community-based approaches.