New plan to tackle leading cause of death in childbirth

A woman is estimated to die every two minutes from causes relating to pregnancy or childbirth

ANALYSIS | AGENCIES | The World Health Organisation (WHO) has released its first roadmap to tackle postpartum haemorrhage (PPH) – defined as excessive bleeding after childbirth – which affects millions of women annually and is the world’s leading cause of maternal deaths.

Despite being preventable and treatable, PPH results in around 70 000 deaths every year. For those who survive, it can cause disabilities and psychological trauma that last for years.

“Severe bleeding in childbirth is one of the most common causes of maternal mortality, yet it is highly preventable and treatable,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General on Oct.11. “This new roadmap charts a path forward to a world in which more women have a safe birth and a healthy future with their families.”

The Roadmap aims to help countries address stark differences in survival outcomes from PPH, which reflect major inequities in access to essential health services. Over 85% of deaths from PPH happen in sub-Saharan Africa and South Asia. Risk factors include anaemia, placental abnormalities, and other complications in pregnancy such as infections and pre-eclampsia.

Many risk factors can be managed if there is quality antenatal care, including access to ultrasound, alongside effective monitoring in the hours after birth. If bleeding starts, it also needs to be detected and treated extremely quickly. Too often, however, health facilities lack necessary healthcare workers or resources, including lifesaving commodities such as oxytocin, tranexamic acid or blood for transfusions.

“Addressing postpartum haemorrhage needs a multipronged approach focusing on both prevention and response – preventing risk factors and providing immediate access to treatments when needed – alongside broader efforts to strengthen women’s rights,” said Dr Pascale Allotey, WHO Director for Sexual and Reproductive Health and HRP, the UN’s special programme on research development and training in human reproduction. “Every woman, no matter where she lives, should have access to timely, high quality maternity care, with trained health workers, essential equipment and shelves stocked with appropriate and effective commodities – this is crucial for treating postpartum bleeding and reducing maternal deaths.”

A woman is estimated to die every two minutes from causes relating to pregnancy or childbirth. There has been limited progress in reducing these deaths since 2015 and the world is off-track for meeting related Sustainable Development Goal targets.

The Roadmap to combat postpartum haemorrhage between 2023 and 2030 outlines goals and activities for research, normative work, implementation and advocacy.

Priority actions include: the development of new and broader guidance for PPH covering prevention, detection and treatment; research to deliver innovations and to increase access to proven interventions; the establishment of a new procurement mechanism to improve the supply of high-quality medicines and commodities; advocacy and awareness-building, and, at the country level, training and facility-based improvements.

About the Roadmap

The Roadmap was developed through extensive consultations involving more than 130 experts across diverse fields, while implementation will be guided by an interdisciplinary steering committee.

WHO and partners will provide specialised technical support to countries to adapt global guidelines into national policies, starting where there is the highest burden of maternal deaths.

WHO acknowledges the contributions and commitments of several partners, including the United States Agency for International Development (USAID), the Bill and Melinda Gates Foundation, the Global Financing Facility, MSD for Mothers, Unitaid, the International Federation of Gynecology and Obstetrics (FIGO), the International Confederation of Midwives (ICM), Jhpiego, Laerdal Foundation, and the United Nations Population Fund (UNFPA).

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Source: WHO