Prevention of postpartum hemorrhage in low-resource settings: current perspectives.

BackgroundPostpartum hemorrhage (PPH) is the leading cause of maternal death in low-income countries and is the primary cause of approximately one-quarter of global maternal deaths. The purpose of this paper is to provide a review of PPH prevention interventions, with a particular focus on misoprostol, and the challenges and opportunities that preventing PPH in low-resource settings presents.MethodsUsing PubMed, we conducted a review of the literature on the randomized controlled trials of interventions to prevent PPH. We then searched PubMed and Google Scholar for nonrandomized field trials of interventions to prevent PPH. We limited our review to interventions that are discussed in the current World Health Organization (WHO) recommendations for PPH prevention and present evidence regarding the use of these interventions. We focused our review on nondrug PPH prevention interventions compared with no intervention and uterotonics versus placebo; this review does not decipher the relative effectiveness of uterotonic drugs. We describe challenges to and opportunities for scaling up PPH prevention interventions.ResultsActive management of the third stage of labor is considered the "gold standard" strategy for reducing the incidence of PPH. It combines nondrug interventions (controlled cord traction and cord clamping) with the administration of an uterotonic drug, the preferred uterotonic being oxytocin. Unfortunately, oxytocin has limited application in resource-poor countries, due to its heat instability and required administration by a skilled provider. New heat-stable drugs and drug formulations are currently in development that may improve the prevention of PPH; however, misoprostol is a viable option for provision at home by a lay health care worker or the woman herself, in the interim.ConclusionAs the main cause of maternal mortality worldwide, PPH prevention interventions need to be prioritized. Increased access to prophylactic uterotonics, regardless of where deliveries occur, should be the primary means of reducing the burden of this complication

Book review: achieving environmental justice: a cross-national analysis by Karen Bell

This book is a valuable and revealing snapshot of current local and global environmental justice issues in a variety of countries, writes Paulo Rui Anciaes. Karen Bell assesses the extent of, and reasons for, environmental justice/injustice in the United States, South Korea, the United Kingdom, Sweden, China, Bolivia, and Cuba, and explores ideas of race and class discrimination, citizen power, industrialisation processes, and the role of capitalism

Potential for cost recovery: women's willingness to pay for injectable contraceptives in Tigray, Ethiopia.

ObjectiveTo investigate factors associated with a woman's willingness to pay (WTP) for injectable contraceptives in Tigray, Ethiopia.MethodsWe used a multistage random sampling design to generate a representative sample of reproductive age women from the Central Zone of Tigray, Ethiopia to participate in a survey (N = 1490). Respondents who had ever used injectable contraceptives or who were interested in using them were asked whether they would be willing to pay, and if so, how much. Logistic regression odds ratios (ORs) with 95% confidence intervals (CIs) and p-values were used to assess which factors were associated with WTP in our final model.FindingsOn average, respondents were willing to pay 11 birr ($0.65 USD) per injection. Being married, completing any amount of education, having given birth, and having visited a health facility in the last 12 months (whether received family planning information or not) were associated with statistically significantly increased odds of WTP. Having initiated sexual activity and having 1-2 children (compared to 0 children) were associated with statistically significantly decreased odds of WTP. We also detected two significant interactions. Among women who prefer injectable contraceptives, their odds of WTP for injectable contraceptives vary across length of time they have used them. And among women who work for pay, their odds of WTP for injectable contraceptives vary by whether they agree with their husband/partner about the ideal number of children.ConclusionIn a sector that continually struggles with funding, cost recovery for contraceptive services may offer a means of improved financial sustainability while increasing rural access to injectable contraceptives. Results indicate there are opportunities for cost recovery in rural Tigray, Ethiopia and highlight factors that could be leveraged to increase WTP for injectable contraceptives

‘Living well’ as a path to social, ecological and economic sustainability

© 2017 by the author. While there is wide agreement on the need to move towards fairer and more sustainable societies, how to best achieve this is still the source of some debate. In particular, there are tensions between more market-based/technological approaches and more redistributive/social approaches. Living Well, a strategy which falls into the latter category, has been proposed as a path to social, ecological and economic sustainability by several state governments of the Global South. This paper examines the Living Well paradigm as implemented in Bolivia through the lens of the recently agreed Sustainable Development Goals (SDGs). The article is based on a 3 year, ESRC funded project on transitions to sustainability and reports the findings of documentary, policy and secondary data analysis, participant observations and semi-structured interviews with local stakeholders. The work indicates that, despite constraints and set-backs, in just a decade, Living Well has achieved a major shift towards social, economic and ecological sustainability in Bolivia. This seems to be primarily a result of the emphasis on redistributive policies, an intention to live in harmony with nature, respect for traditional values and practices, local control of natural resources, and participative decision-making. It is, therefore, argued that other nations might achieve more success in transitioning to sustainability by focusing on these factors, rather than continuing to emphasise the technological/growth/market approaches which are currently dominating global sustainability debates and activities

Green economy or living well? Assessing divergent paradigms for equitable eco-social transition in South Korea and Bolivia

'Green Economy' and 'Living Well ('Vivir Bien)' have emerged as contending macro-policies in the search for a future direction that meets human needs whilst respecting environmental limits. There are a number of different interpretations of each concept but the dominant discourses in relation to each are distinct. Green Economy is presented as a fundamentally technological, managerial and market-based approach, whilst Living Well is considered to imply redistribution of wealth, inter-personal and inter-species reciprocity and eco-socialist development in harmony with nature. Contributing to the debate on the most effective strategic direction to take to achieve equitable and effective eco-social transition, this article examines the processes, politics and early impacts of attempts to implement these macro-policies in South Korea, a global Green Economy leader, and Bolivia, at the forefront of promoting the Living Well approach