British Medical Journal Criticises Indian Govt's Advisory On Oxytocin

The British Medical Journal has recently criticised the Indian Health Ministry's advice to delay oxytocin at childbirth. In a report published by the BMJ, doctors and maternal health experts have questioned the “ethics” and “scientific rationale” behind the Government's advisory that asks to delay giving oxytocin until after the uterus has expelled the placenta.

What The Advisory Said

On the November 6, an advisory was sent to health officials in all Indian states and Union Territories. The advisory stated that there should be delayed administration of oxytocin to women at the time of childbirth. Health officials, according to the advisory, would wait until after the uterus had expelled the placenta. This could take five to ten minutes.

“This raises questions about science and ethics. Can a government reverse established guidelines on the basis of just one or two studies? Any health policy proposed without adequate evidence would be unethical—and this one also has the potential to harm women.”

The Indian Health Ministry's advice goes against the World Health Organisation standards. WHO states that oxytocin must be given to women within a minute of childbirth. Most countries, including India, have been following this protocol for years.

What Oxytocin Does

Postpartum Haemorrhage is commonly defined as a blood loss of 500 ml or more within 24 hours after birth. PPH is the leading cause of maternal mortality in low-income countries. It is also the primary cause of nearly one-quarter of all maternal deaths globally.

According to WHO, “the use of uterotonics for the prevention of postpartum hemorrhage (PPH) during the third stage of labour is recommended for all births. Oxytocin is the recommended uterotonic drug for the prevention of PPH.” The risk of PPH can be brought down by around 70 percent with timely oxytocin delivery.

READ ALSO: Why Lifting Oxytocin Ban Is Life-Saving For Pregnant Women 

 Dr Shivani Chaturvedi talked to SheThePeople.TV about the use of the drug in the medical sector. She explained, “Oxytocin is a very vital drug, in most cases, it is used to initiate or augment the delivery and it has been used for 50 years now.”

Then Why Delay Oxytocin?

The World Health Organisation, as well as medical experts agrees that oxytocin is safe and must be given to women. This gives rise to the question of why the Indian Health Ministry issued the advisory. The recommendations of the Government are based on a study conducted on women and babies in a district in Gujarat, as well as a few in a Kolkata hospital. According to Dr. Arun Singh, who led the study, it seeks to recognise childbirth as a natural physiological process and pull away from the current “overmedicated” approaches. “Natural oxytocin, which the mother herself produces, is far superior to artificially injected oxytocin. Naturally produced oxytocin allows the upper part of the uterus to contract and facilitate natural expulsion of the placenta — most women do not need artificial oxytocin injections.”

However, many have raised questions on how a Government can issue an advisory based on just one study. “Is a single study on 348 women enough to alter national policy and turn away from globally accepted protocols?” asked Subhasri B., an obstetrician-gynaecologist with CommonHealth, a health group engaged in maternal and newborn health.

READ ALSO: What The Ban On Life-Saving Drug Oxytocin Means 

BMJ's Objections

Prabir Chatterjee, a community medicine specialist at the State Health Resource Centre in the central-eastern state of Chhattisgarh, told BMJ that the advisory could put pregnant women at risk. “The recommendation on oxytocin is silly and dangerous. It could put pregnant women at risk of harm or death,” he said.

According to WHO, “the use of uterotonics for the prevention of postpartum hemorrhage (PPH) during the third stage of labour is recommended for all births. Oxytocin is the recommended uterotonic drug for the prevention of PPH.” The risk of PPH can be brought down by around 70 percent with timely oxytocin delivery.

In the BMJ's report, Amar Jesani, a physician and editor of the Indian Journal of Medical Ethics, also said, “This raises questions about science and ethics. Can a government reverse established guidelines on the basis of just one or two studies? Any health policy proposed without adequate evidence would be unethical—and this one also has the potential to harm women.”

Ultimately, the BMJ report has raised questions on the ethical system behind the Government's advisory. If such an advisory takes the form of national policy, it also has the potential to cause harm to women all over the country.

PC: Medical News Today

Prapti is an intern with SheThePeople.TV