In a paper presented at the annual meeting of the American Public Health Association last month, researchers explored the choices patients in developing countries make when choosing to buy - or not to buy - expensive Western medicines. Rose Hoban reports.
It doesn't seem to make sense. Of course people would do whatever they could to obtain life-saving medications. But in many countries, patients often don't have the choice of whether or not to pay for drugs because they're too expensive.
But now, new research from Tanzania shows women will pay for a medicine to prevent excessive bleeding after giving birth - a condition known as postpartum hemorrhage.
Martine Holston says there are many reasons women in Tanzania might been reluctant to pay for Western medicine, aside from cost.
"Perhaps fears of Western medicine, drugs... suspicion. Perhaps husbands not wanting to let them use it," Holston says. "There can be a lot of, I would say, cultural issues around using medicine that perhaps might be one reason women wouldn't want to use it.
"And I do know that in some women, there was a little bit of a fear of perhaps the pill being a contraceptive, particularly, I believe, among Muslim women."
Holston works for Venture Strategies for Health and Development, a nongovernmental organization targeting deaths related to childbirth. She says traditional birth attendants in Tanzania have long known that postpartum hemorrhage can be deadly.
"They use a local garment called a kanga," Holston says. "Two of these kangas - which are a standard size - soaked with blood is the threshold for postpartum hemorrhage. Almost exactly 500 milliliters."
Holston says, until now, the traditional birth attendants have had few tools to deal with the problem. So, when a woman experiences postpartum hemorrhage, they usually send the woman to a local clinic or hospital after she soaks four or five kangas. But often, the women die before they get treatment. So Holston and her coworkers trained the birth attendants to give women a drug called misoprostol after soaking just two kangas.
The question was, would women be willing to pay for this Western medicine, which costs about the same as a day's worth of food?
"If women had received postpartum hemorrhage knowledge from a traditional birth attendant, they were more willing to pay for the drug," Holsten says. "And if their last birth had been assisted by a traditional birth attendant, they were also more willing to pay."
Holston was surprised to find that in communities where no one had heard of misoprostol, women were even more willing to pay for a drug that could stop postpartum hemorrhage.
"Once the traditional birth attendant explained to her that, 'No, this isn't a contraception. This is just for bleeding after childbirth. There's no other effects of the drug…' the woman was completely amenable to it," Holsten reports.
Holston says these results indicate it would be wise to increase availability of misoprostol in rural areas and train more traditional birth attendants to use the medication.