Good-quality medicines, given at the right time, can save the lives of pregnant and recently pregnant women and their newborn babies. New evidence synthesis reveals however, that in many health-care settings across the world, women with life-threatening maternal complications are given poor quality medicines – putting their lives and well-being at grave risk.

The systematic review, authored by staff at WHO Department of Sexual and Reproductive Health and Research including HRP, and collaborators published in PLOS ONE, shows that in many low- and middle-income countries, low-quality medicines are used to manage life-threatening maternal conditions.

Maternal mortality

It is both tragic and unacceptable that so many women, particularly those living in low- and middle-income countries continue to die from causes related to health complications related to pregnancy, childbirth and the postpartum period. The most recent estimates showed that every day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth. 

Preventable with the right treatment

Frequent life-threatening maternal complications include post-partum haemorrhage, pre-eclampsia/eclampsia, and sepsis. With timely and effective care and medications, any serious repercussions caused by these complications can often be avoided. Uterotonics (drugs used to stop bleeding, particularly for postpartum haemorrhage) such as oxytocin, are effective in preventing post-partum haemorrhage. Antibiotics administered during labour or after birth can prevent or treat sepsis for both women and their newborn babies. And magnesium sulphate can help to prevent and/ or treat eclampsia. These are medical options that are both affordable and effective.

“Out of specification” and poor-quality drugs

There are growing concerns about the negative impact upon health of substandard and falsified medicines (also known as “out of specification” drugs) particularly in low- and middle-income countries. The new systematic review shows, however, that in many health-care settings in low- and middle-income countries, poor quality versions of these drugs are often provided. The findings suggest that this problem could contribute to the persistence of the high numbers of severe complications and deaths caused by pos partum haemorrhage, eclampsia, and sepsis in low- and middle- income countries. 

The new study showed that nearly half (48.9%) of all uterotonic drugs sampled failed quality assessments. 1 in 7 injectable antibiotic samples (13%) and 1 in 29 magnesium sulphate samples (3.4%) were of low quality.

Nearly half of the samples assessed were collected since 2011, indicating that this is an issue of current global concern that requires immediate attention. The study also looked at differences in quality of medicines between the private and public sector, and found that in general, higher failure rates were in the private sector. This finding underlines the crucial need for national procurement bodies or private providers to procure medications that adhere to WHO prequalification, or similar stringent requirements.

Quality and dignity

Every woman has the right to quality care before, during and following pregnancy and childbirth. The informed provision of good quality medicines, at the right time, is crucial for ensuring high quality and dignified care for women and their newborn babies.

Health-care providers need also to be able to access good quality medicines in order to properly care for women. They should also receive proper training in how and when to administer these drugs. This is crucial as they work to uphold the Hippocratic oath of ‘do no harm’.

Mariana Widmer, a Scientist at WHO and HRP, and an author of the paper reflects, “Health care workers need to be able to know they are truly caring for women, and treating any health complications of pregnancy and childbirth effectively. We need to ensure they receive training to provide medications, and that medications are always good quality.