{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T01:45:26Z","timestamp":1776217526919,"version":"3.50.1"},"reference-count":46,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>The global impact of life\u2010saving medical devices is directly related to their availability. Access may be limited by cost, availability, or lack of information regarding effectiveness and safety. Addressing the inequity in access requires concerted effort from device developers, the research community, global agencies and professional organisations. We discuss, with examples, three strategies to promote equity: low\u2010cost, purpose\u2010built innovation, improvisation and off\u2010label use. First, developing simple, safe and low\u2010cost innovative devices can be an effective way of increasing global access. For example, the BabySaver Kit facilitates intact\u2010cord neonatal bedside resuscitation. Re\u2010usability is an important design feature for both cost and environment, exemplified by the MaternaWell tray for blood loss monitoring after birth. A second strategy is improvisation using commonly available hospital items. This can extend device availability into settings where purpose\u2010designed devices are unavailable or unaffordable. Examples include the use of condoms or glove balloons for uterine balloon tamponade (UBT) to treat postpartum haemorrhage (PPH), elastic catheters for uterine tourniquet, and plastic tubing for posterior axilla sling traction in shoulder dystocia. However, the lack of systematically developed evidence and governance approvals can lead to wide variation in training, technique, and device specifications. Finally, some of these quality issues are addressed by using approved medical devices \u2018off\u2010label.\u2019 However, they can have similar problems of variation in technique and depend on the uncoordinated efforts of researchers and clinicians to generate an evidence base. Examples include the Foley catheter for labour induction and the Levin stomach tube for suction tube uterine tamponade for PPH. WHO has pathways to facilitate global access to important public health device innovations. Global agencies and professional organisations also have a major role to play in providing co\u2010ordination, platforms for data sharing, practice guidelines, instructions for use on off\u2010label devices and robust data on their safety and effectiveness.<\/jats:p>","DOI":"10.1111\/1471-0528.70058","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T12:11:49Z","timestamp":1760443909000},"page":"1903-1909","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Achieving Equitable Access to Obstetric Devices Through Innovation, Improvisation and Off\u2010Label Use"],"prefix":"10.1111","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3080-1007","authenticated-orcid":false,"given":"G. Justus","family":"Hofmeyr","sequence":"first","affiliation":[{"name":"Effective Care Research Unit University of the Witwatersrand and Walter Sisulu University  East London South Africa"},{"name":"Department of Obstetrics and Gynaecology University of Botswana  Gaborone Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mandisa","family":"Singata\u2010Madliki","sequence":"additional","affiliation":[{"name":"Effective Care Research Unit University of the Witwatersrand and Walter Sisulu University  East London South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara Della","family":"Ripa","sequence":"additional","affiliation":[{"name":"ArcHealth Foundation  Hinesburg Vermont USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1909-337X","authenticated-orcid":false,"given":"Andrew D.","family":"Weeks","sequence":"additional","affiliation":[{"name":"Sanyu Research Unit, Department of Women's and Children's Health University of Liverpool  Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(25)00062-2"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0003418"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1744-8603-10-1"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000005839"},{"issue":"6","key":"e_1_2_11_6_1","article-title":"Effects of Combinations of Diagnostic and Treatment Strategies for Postpartum Haemorrhage: A Network Meta\u2010Analysis","volume":"6","author":"Yunas I.","year":"2025","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_11_7_1","volume-title":"Personal Communication","author":"Fornu F.","year":"2024"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1155\/2024\/6605833"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.13817"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)02469-8"},{"issue":"6","key":"e_1_2_11_11_1","first-page":"526","article-title":"The BabySaver: Design of a New Device for Neonatal Resuscitation at Birth With Intact Placental Circulation","volume":"8","author":"Ditai J.","year":"2021","journal-title":"Children (Basel)"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-015-0012-0"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-066907"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-022-01551-2"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/OGX.0000000000001061"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2015.05.020"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-020-2721-9"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14156"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016590"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15903"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0245988"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16819"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004674"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2023.01.016"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2009.02373.x"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-020-03526-2"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurox.2024.100285"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2024.07.027"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12704"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2022.11.009"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001703-200112000-00005"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008982.pub2"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16382"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.13551"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurox.2023.100226"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13224-017-0963-x"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tjog.2024.08.005"},{"key":"e_1_2_11_38_1","article-title":"Vacuum\u2010Induced Management of Hemorrhage Using Intrauterine Foley Catheter: A Report of Two Cases","volume":"18","author":"Jackson F. 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