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December 21, 2017
Greetings from New York,

Making reproductive and maternal health innovations accessible in low-resource settings is one of Gynuity's core goals. Our work promoting the use of low-tech approaches to safe abortion and post-abortion care, management of postpartum hemorrhage, and preeclampsia, includes the involvement of non-physician health care providers. Our recent project promoting task-sharing and optimizing health worker roles in Mexico is described in our    "Spotlight on..."   feature below. This project is part of a large initiative funded by the MacArthur Foundation  to expand midwifery care in Mexico.

As always, we welcome your comments and wish you a grand finale to 2017!

We are pleased to share the compendium of resources developed for Gynuity's project to raise awareness among health professionals in Mexico about midwifery practice and team-based approaches to maternal and newborn health (MNH) and sexual and reproductive health (SRH) care.
The compendium, "Evidence on midwifery and task-sharing for maternal and neonatal health and sexual and reproductive health care: Compendium and training course for clinical providers  (Evidencias sobre partería y tareas compartidas para la atención en salud materna y neonatal y salud sexual y reproductiva: Compendio y curso para prestadores clínicos)," 
contains the following resources: 
  1. Project and course description outlining project aims and content of a training course developed to disseminate evidence-based resources on midwifery and task-sharing for MNH and SRH care. 
  2. Annotated bibliography summarizing eight peer-reviewed articles that describe the foundational concepts of the course. 
  3. Resource list offering a selection of articles, reports and clinical practice guidelines, and links to on-line courses, videos and resources.  
  4. Training course in PowerPoint disseminating evidence and information on key concepts.
*Please note, the training course and project documents are currently available only in Spanish.
Route of oxytocin for PPH prevention
Gynuity has developed a  one-page document summarizing the findings from a series of randomized controlled trials conducted among women with vaginal births in tertiary-level hospitals comparing the effect on postpartum blood loss of the most common routes of oxytocin administration: intravenous infusion (IV), IV bolus, and intramuscular (IM) injection of 10 IU oxytocin. We offer the following guidance for clinical practice: 1) If an IV line is already in place, oxytocin infusion may be preferable to IM injection for the prevention of PPH; 2) Giving a prophylactic dose of oxytocin by IV bolus is a safe option in vaginal births for PPH prevention and should be considered when IV infusion is not feasible; and 3) IM injection may be the fastest way of administering a prophylactic uterotonic after childbirth if no IV line or port is set up. 
Updated instructions for use brochure: Misoprostol for treatment of postpartum hemorrhage
Gynuity Health Projects has revised its Instructions for Use (IFU) brochure on the correct use of misoprostol for treatment of postpartum hemorrhage (PPH). The IFU, first developed in 2011, offers concise, easy-to-digest recommendations for clinical practice and is presented for the guidance of healthcare providers. Gynuity consulted professionals with epidemiological, clinical and programmatic expertise on PPH treatment and misoprostol to reach consensus on dosing, usage, precautions and side-effects. This IFU brochure is part of a series and is available to download in English  here.
International Meeting on Postpartum Hemorrhage (PPH): No Magic Bullets: Translating Evidence into Effective PPH Programs, New York, December 5-6, 2017
In December, some 90 researchers, program implementers, clinicians, and policymakers from around the world gathered in New York to consider ways to translate their collective knowledge on PPH into effective, context-driven programs. The two-day meeting, hosted by Gynuity, opened with a review of recent evidence on a number of interventions and technologies for PPH management, including uterotonics, tranexamic acid and uterine balloon tamponade. The opening sessions were followed by further presentations, analysis and discussion on new triggers for PPH intervention -- including the role of shock index in PPH diagnosis and treatment -- and on the essential components for integrating new PPH technologies into services and strengthening the quality and effectiveness of PPH care. The meeting ended with a moderated panel discussion, comprised of senior representatives from leading agencies engaged in PPH efforts in low and middle income countries, on future priorities for programs and research.

Abortion Reversal Meeting, New York, November 15, 2017
The Mife Coalition organized "Reverse the Rhetoric," a meeting convened to address claims by the anti-abortion movement that medical abortion can be reversed using regimens of progesterone. Forty-five members of the Coalition attended the meeting, and an additional 27 members participated in the live stream of the meeting. The meeting provided a forum to discuss: 1) how "mifepristone reversal" has intruded upon the lives of providers and women; 2) whether we should develop a proactive research agenda on this topic; and 3) how we can communicate effectively about this issue. The meeting's participants concluded that informational materials are needed to inform abortion providers, clinic staff, other medical professionals, and policy-makers about the inadequacies of the "evidence" that has been produced by anti-abortion groups. More importantly, there is an urgent need to provide evidence-based information to women with messaging that is sensitive to the circumstances of low-income women and women of color. In collaboration with the members of the Coalition, Gynuity will develop materials to provide evidence-based medical information to inform providers, advocates, policy-makers, and women about what is known and not known about so-called "abortion reversal."

Lessons Learned from Evaluating the Scale-Up of Postpartum Hemorrhage (PPH) Technologies in Maternal Health Programs, September 14, 2017
Gynuity held a webinar to share lessons learned and program experiences from Nepal, Niger and Nigeria on scale up of PPH technologies and of maternal and newborn health (MNH) interventions. Moderated by Gynuity's Senior Director, Rasha Dabash, the webinar included the following presentations and speakers:  "Misoprostol for PPH prevention in Nepal: A program assessment", Dr. Wendy Sheldon, Gynuity Health Projects and Dr. Swaraj Pradhan Rajbhandari, M4health; "National scale-up of Niger's PPH Initiative: Lessons learned from introducing new strategies into services", Dr. Zeidou Alassoum, Health Development International Niger and Meighan Tarnagada, Gynuity Health Projects; and "An integrated approach to reducing maternal and neonatal mortality: Evaluating MNH interventions in Northern Nigeria", Andrew Storey, Clinton Health Access Initiative and Dr. Olufunke Fasawe, Clinton Health Access Initiative. The presentations are available upon request.
Murtagh, C., Wells, E., Raymond, E., Coeytaux, F., Winikoff, B. Exploring the feasibility of obtaining mifepristone and misoprostol from the internet. Contraception. 2017 Oct 11. pii: S0010-7824(17)30475-4. doi: 10.1016/j.contraception.2017.09.016. [Epub ahead of print]

Alam, A., Lotarevich, T., Das, T.R., Reichenbach, L., Bracken, H. Mifepristone-misoprostol for menstrual regulation in public sector facilities in Bangladesh. Int J Gynecol Obstet. 2017 Oct 19. doi: 10.1002/ijgo.12356. [Epub ahead of print]

Ditai, J., Frye, L.J., Durocher, J., Byrne, M.E., Ononge, S., Winikoff, B., Weeks, A.D. Achieving community-based postpartum follow up in eastern Uganda: The field experience from the MamaMiso Study on antenatal distribution of misoprostol. BMC Res Notes. 2017 Oct 26;10(1):516.

Raymond, E.G., Tan, Y.L., Comendant, R., Sagaidac, I., Hodorogea, S., Grant, M., Sanhueza, P., Van Pratt, E., Gillespie, G., Boraas, C., Weaver, M.A., Platais, I., Bousieguez, M., Winikoff, B. Simplified medical abortion screening: A demonstration project. Contraception. 2017 Nov 20. pii: S0010-7824(17)30522-X. doi: 10.1016/j.contraception.2017.11.005. [Epub ahead of print]

Raymond, E.G., Tan, Y., Grant, M., Benavides, E., Reis, M., Sacks, D.N., Hannum, C., Frapp, S., Weaver, M.A. Self-assessment of medical abortion outcome using symptoms and home pregnancy testing. Contraception. 2017 Dec 11. pii: S0010-7824(17)30530-9. doi: 10.1016/j.contraception.2017.12.004. [Epub ahead of print]
SPOTLIGHT ON...Spotlight
Midwifery and task-sharing to improve maternal and neonatal health (MNH) and sexual and reproductive health (SRH) care in Mexico

Gynuity has been working in several Mexican states since 2016 to increase awareness about best practices for low-risk pregnancies and births. In recent years, Mexico has achieved a high rate  (94%) of institutional births as a strategy to reduce maternal mortality. An unintended consequence is that public health sector services have been overwhelmed with low-risk births, diverting limited resources from cases requiring higher level skills and training. The WHO, UNFPA, and the International Confederation of Midwives (ICM), among others, have called for using midwifery care to ease the burden on healthcare resources. We seek to support the entry of professional midwives and obstetric nurses into the healthcare system through the following key activities:
  • Compiling and disseminating evidence-based resources on task-sharing MNH and SRH care into a resource compendium and creating a one-day course based on its key concepts.
  • Identifying and training multidisciplinary teams of clinical trainers and spokespersons to lead dissemination efforts.
  • Educating medical practitioners and students on best practices for low-risk pregnancy and birth.
  • Exploring health care administrator willingness to integrate midwifery professionals into their services.
As of December 1st the course has been implemented with almost 300 decision-makers, health care providers, and nursing students in Guerrero, Hidalgo, and Mexico City. Results of an evaluation of knowledge, attitudes, and perceptions of course participants will be disseminated in 2018.   

Gutiérrez JP, Rivera-Dommarco J, Shamah-Levy T, Villalpando-Hernández S, Franco A, Cuevas-Nasu L, Romero-Martínez M, Hernández-Ávila M. Encuesta Nacional de Salud y Nutrición 2012. Resultados Nacionales. Cuernavaca, México: Instituto Nacional de Salud Pública (MX), 2012.
Tel: 1+212.448.1230