Improved obstetric care is helping families in Benin including the Ganse family pictured here.

For my previous delivery in the Bohicon maternity, I went into labor at about 7:45 am. By 8:30 am I had lost consciousness due to a major hemorrhage. The health facility was not able to stop the hemorrhage”.

For many women like Ms. Ganse, giving birth in Benin continues to be a life-threatening event. National figures indicate that as many as 400 women die per 100,000 live births. Most maternal deaths -- more than a third -- are due to excessive uterine bleeding (PPH) that sometimes occurs after childbirth. To reverse this alarming trend, USAID/Benin’s Integrated Family Health Project (PISAF), which is implemented by University Research Corporation, is introducing a proven approach called Active Management of the Third Stage of Labor (AMTSL) to reduce childbirth hemorrhages. Although the Ministry of Health adopted AMTSL, many facilities are struggling to put it into practice.

An approach called the "improvement collaborative" (I.C.) aims to improve the functioning of the health system so that policies can be translated into effective practice. In collaboratives, practitioners from different levels of the health system work together to determine ways to rapidly improve quality in a specific health care area. After successful testing, teams apply the proposed set of new practices and changes on a larger scale. In 2008, PISAF launched an I.C. in central Benin to improve maternal and newborn care, with a focus on AMSTL. The I.C. ensures that all participating health facilities provide the three components of AMTSL:

1. Administering a drug immediately after the birth of the baby to prevent hemorrhages;

2. careful traction of the umbilical cord, and

3. Uterine massage.

The I.C. also includes essential newborn care and infection prevention. PISAF has made rapid progress in applying AMTSL. As performance of all three elements rose from 73 percent to 98 percent in less than a year, post-partum hemorrhage dropped by 53 percent.Due to the success of the I.C. in re-ducing PPH in its initial demonstration phase, PISAF will expand the program to 22 new health centers in June 2009. PISAF also plans to add interventions to prevent other significant causes of maternal mortality. Of her experience giving birth after the launch of PISAF’s I.C..

Ms Ganse gave this moving account: “My husband and I expected the worst. To our immense relief, everything went well and I hardly bled at all, even with the suture from the episiotomy I had.”
“Moreover, added the husband, it only cost 10,000 francs this time, compared to the 150,000 francs it cost last time. Not to men-tion the psychological stress from the fear of losing my wife."

This story highlights not only the powerful life-saving effect of these intervention, but also the cost-effectiveness of improving care quality.