Carbetocin: A new weapon in the fight against maternal mortality?

India is a safer country to be a mother than it was twenty years ago. Could a new version of the drug carbetocin make it even safer?

In 1990, 556 Indian mothers lost their lives for every one lakh (100,000) live births. 2016 saw this figure drop by 77 percent to 130 deaths for every one lakh live births. Between the 2011-13 and 2014-16 periods alone, India cut its MMR by 22 percent.

The progress India has made in this regard represents a significant public health achievement – one the World Health Organization (WHO) has called “groundbreaking”. Nevertheless, there is still work to do. Every day, pregnancy-related complications kill 800 women worldwide. Twenty percent of these women are from India.

The leading cause of deaths in childbirth is postpartum hemorrhage (PPH). This is true, both worldwide and in India, where PPH accounts for 38 percent of maternal deaths.

This is where carbetocin comes in.

Carbetocin: A more accessible option?

A new, heat-stable formulation of the drug could be a more accessible option for new mothers in lower middle-income countries (LMICs) and developing nations. This is according to research published in The New England Journal of Medicine, conducted by the WHO, MSD for Mothers and Ferring Pharmaceuticals.

The study concludes that carbetocin can prove as effective as oxytocin, which the WHO currently recommends for use in staunching PPH.

In dealing with PPH, there are practical considerations which could give carbetocin the edge over oxytocin. The latter must be transported and stored at temperatures of two to eight degrees celsius.

The need for refrigeration limits the accessibility of the drug for many women in India, where electricity supply is inconsistent in many healthcare facilities. As the Council on Energy, Environment and Water (CEEW) reported last year, one in every two primary health centres (PHCs) across the country either suffer from an irregular power supply – or aren’t electrified at all. As Health Issues India reported last year, unelectrified health centres service almost 35 million Indians.

Safer places to give birth?

Other issues might soon come into play in India limiting the availability of oxytocin. Recently, the Centre banned the manufacture and sale of oxytocin by private companies for domestic use. The ban was announced after it emerged that dairy farmers were injecting cows with it in order to artificially increase milk production.

The ban was initially to come into effect from July 1st. However, the Centre postponed it to September after it was expressed that Karnataka Antibiotics and Pharmaceuticals, Ltd. – the public sector firm solely licensed to produce oxytocin in India after the ban comes into force – might struggle to satisfy the demand for the drug after being given such short notice on rollout of the ban.

Transitioning from oxytocin to carbetocin could prove a valuable tool in helping India to capitalise on its already considerable progress in saving the lives of its mothers. This, in turn, would make the country and its health facilities safer places to give birth.

The study can be accessed here.