Reducing inequities in access to postpartum hemorrhage prevention: Reframing advance distribution of misoprostol as a test case for health system responsiveness and adaptation

Advance distribution of misoprostol is an evidence‐based strategy for preventing postpartum hemorrhage (PPH) at births without skilled health personnel present. Despite its lifesaving potential, initial momentum behind this intervention has slowed over the last decade and has not been renewed since WHO released updated guidelines in 2020 or the global Roadmap to combat postpartum hemorrhage between 2023 and 2030 was launched in 2023. The present article argues for renewed consideration of advance distribution of misoprostol in comprehensive PPH prevention strategies and reframing of policy dialogues around the intervention to reflect current health system realities and public health imperatives. Drawing on experiences of the Accelerating Measurable Progress and Leveraging Investments for Postpartum Hemorrhage Impact (AMPLI‐PPHI) project across six diverse health systems, we position advance distribution of misoprostol as a litmus test for health system responsiveness and call on health sector stakeholders to critically examine all available opportunities to optimize PPH prevention strategies and accelerate efforts to reduce inequities in preventable maternal mortality.