Securing reproductive rights [letter]

Sir—Your series on reproductive health and rights highlights the political cultural and industrial issues that hinder improvement of the sometimes inaccurate maternal death figures. Specific experiences and difficulties encountered when addressing this problem could be helpful for planning future interventions. The Health Ministry of Nicaragua started a countrywide programme for developing local therapeutic guidelines through an international external consultation. Post partum haemorrhage was chosen as the first health problem to be addressed. A pre-intervention study to describe perinatal-mother management at the Hospital Aleman-Nicaraguense (HAN) in Managua showed extensive use of ergometrine during delivery. Evidence of the inefficiency of ergometrine in adverse climate conditions was discussed with HAN personnel and the national regulatory authorities. However we encountered reluctance to change prescription behaviour based on non-controlled “personal good clinical experience” with ergometrine and “lack of local data on pharmaceuticals of substandard quality”. (excerpt)