n South African Medical Journal - Maternal deaths from bleeding associated with caesarean delivery : a national emergency : editorial




In this issue of the , Fawcus draw attention to the epidemic of avoidable maternal deaths from caesarean-related haemorrhage in South Africa (SA). How can this epidemic be addressed? Firstly, the most effective and cost-effective way to reduce maternal mortality from all causes is by preventing unintended pregnancies. In SA we have proved our capacity to mainstream the largest HIV treatment programme in the world into all levels of our health services. We need to do the same for family planning. In particular, the copper intrauterine contraceptive device (IUCD) needs to be made more accessible as an option. Current limited evidence suggests that the IUCD is more effective than injectable progestogens. Health workers need training in counselling and techniques of inserting the IUCD after pregnancy termination, after vaginal birth and at caesarean section, as well as in interval insertion.


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