A recent World Bank data puts the maternal mortality ratio (MMR) for India reported in 2015 at 174 per 100,000 live births, which is a significant decline from the 215 figure that was reported in 2010. In absolute numbers, nearly 45,000 mothers die due to causes related to childbirth every year that accounts for 17% of such deaths globally.

The major cause— Post-Partum Haemorrhage is often defined as the loss of more than 500-1,000 ml of blood within the first 24 hours following childbirth. Despite improvements in maternal mortality, haemorrhage continues to be the largest direct cause of maternal death, accounting for 661,000 deaths worldwide between 2003 and 2009; India accounts for 17% of the global burden of maternal deaths and the leading causes of death in India are haemorrhage (38%), sepsis (11%) and abortion (8%), as FactChecker reported on June 19, 2018.

_UPI.com

According to a new study, an improved version of the drug carbetocin could save Indian mothers who die due to postpartum haemorrhage.

Oxytocin – currently recommended by the World Health Organisation to prevent excessive bleeding during childbirth – must be stored and transported at 2–8 degree Celsius, which is hard to do in many countries, including India, depriving many women of access to this drug, said the World Health Organisation study, published in the New England Journal of Medicine on June 27, 2018.

This is where carbetocin comes into play. The new avatar of carbetocin does not require refrigeration and retains its efficacy for at least three years stored at 30 degrees C and 75 percent relative humidity, as opposed to oxytocin — widely used but manufacture and sale were recently banned for private manufacturers — which needs refrigeration. This is critical because, of 37,387 Indian health sub-centres–basic government-run clinics–24 percent do not have electricity, with Jharkhand being the worst at 70 percent, followed by Bihar (64 percent) and Jammu & Kashmir (63 percent), writes IndiaSpend.

According to a study by WHO, researchers found that heat-stable carbetocin is as safe and effective as oxytocin in preventing postpartum haemorrhage. This was found out when researchers studied 29,245 women who gave birth vaginally at 23 hospitals in 10 countries–Argentina, Egypt, India, Kenya, Nigeria, Singapore, South Africa, Thailand, Uganda and the United Kingdom.

“Apart from fact that efficacy of oxytocin depends on certain conditions, across India, there is even a lack of awareness that oxytocin needs to be stored as a specific temperature and refrigeration,” Shivaprasad S. Goudar, a professor at the Jawaharlal Nehru Medical College, Belgaum, and co-author of the study, told IndiaSpend. “And, therefore, the quality of oxytocin administered to pregnant women is sub-optimal.” “The study’s results hold a lot of promise,” said Subhasri, chairperson, CommonHealth, a coalition working on maternal-new-born health and safe abortion.

Its not as simple as it sounds. There are mainly three challenges, according to Subhasri, to taking carbetocin national: One, the study doesn’t show that carbetocin is as effective as oxytocin for severe bleeding (more than 1,000 ml), and more trials may be necessary to prove carbetocin’s effectiveness to stanch severe bleeding; two, oxytocin is a drug out of patent, whereas carbetocin is under patent and is likely to be costlier; and three, as with oxytocin, there is a “huge potential” of carbetocin misuse such as farmers using them on livestock to milk them according to their convenience, breaking their natural cycle.

So oxytocin is the next big thing for Indian health market if the challenges are overcome.