Postpartum haemorrhage is the leading cause of maternal death worldwide, responsible for around 100,000 deaths every year. While around 6 per cent of women giving birth all over the world – in rich and poor countries alike – develop postpartum haemorrhage, 99 per cent of deaths from it occur in low- and middle-income countries. A recent clinical trial found that a cheap, out of patent drug – tranexamic acid – is hugely effective in reducing these deaths. But in many of the countries that need it most, it isn’t always easily available.
In a reported story for Mosaic, I travelled to Pakistan and Nigeria to explore what comes next after a successful clinical trial, and to look in depth at the fightback against high maternal mortality rates.
When the trial results came out in April 2017, the doctors who had worked on it in Pakistan were jubilant. Tranexamic acid, which stops blood clots from breaking down, works in a totally different way from other drug treatments for postpartum haemorrhage, which mainly focus on helping the uterus to contract. “If the patient has had the uterotonic drugs and needs two transfusions, the addition of tranexamic acid means the need for blood transfusions is reduced, as is the need for surgery,” explains Khan. “It’s easily available, cheap, very effective. It’s a magic drug.”
In recent years, there has been a lot of discussion about the “public health approach” to tackling violence, with suggestions that such a model could be introduced in London to counter rising knife crime. But what does a public health approach to violence actually mean in practice? In this piece for Mosaic, I spent time in Glasgow – where a public health model has been highly effective – and in Chicago, where this approach was first developed.
Humans engage in a wide array of risky behaviours that can lead to serious health problems: smoking, overeating, sex without protection. It has long been the accepted wisdom that doctors should encourage patients to change their behaviour – give up smoking, go on a diet, use a condom – rather than wait to treat the emphysema, obesity-related heart attacks, or HIV that could be the result. Yet when it comes to violence, the discussion is often underpinned by an assumption that this is an innate and immutable behaviour and that people engaging in it are beyond redemption. More often than not, solutions have been sought in the criminal justice system – through tougher sentencing, or increasing stop-and-search (despite substantial evidence that it is ineffective in reducing crime). Is enforcement the wrong tactic altogether?
Mosaic publishes everything under a Creative Commons licence, meaning their pieces are free to republish elsewhere. A version of this article ran simultaneously in the Guardian’s Long Read section (it was also featured on the front page of the newspaper that day), and was later picked up by CNN, the BBC, and the Independent, among others.