EDITORIAL
Postpartum hemorrhage is a political failure—yet it can be prevented
by Mutula Kilonzo Jr.
International Journal of Gynecology & Obstetrics , Free Access
Vol. 173, Issue 2, May 2026 https://doi.org/10.1002/ijgo.70922Digital Object Identifier (DOI)
All the articles first appeared in March 2026. The texts below are the published versions from May 2026.
These five articles also appear in: XXV FIGO World Congress President’s Session: Postpartum Hemorrhage
Postpartum hemorrhage (PPH) remains one of the leading causes of maternal death globally, not because it is untreatable, but because societies and systems have failed to prioritize women’s lives. This is not primarily a clinical failure; it is a political one.
PPH is predictable. It is diagnosable. It is treatable. Yet in countries such as Kenya, maternal mortality ratios remain unacceptably high—around 355 deaths per 100 000 live births in Kenya, and closer to 400 in other parts of East and West Africa. These numbers are not abstractions. They represent women who died bringing life into the world, and families permanently altered by loss. If such mortality rates affected men, the global response would be immediate and uncompromising.
A critical gap in the fight against PPH is political engagement. Policymakers usually respond to data, scale, and visibility, yet maternal deaths (particularly those occurring during childbirth) remain largely invisible within political decision making. Too often, those with the power to allocate resources, shape health systems, and remove barriers are absent from the conversations that could effect change.
Where political leadership aligns with evidence-based care, the results are striking. In settings where heat-stable uterotonics such as heat-stable carbetocin have been introduced, particularly in areas where cold-chain storage for oxytocin is unreliable, maternal deaths from PPH have been dramatically reduced. These outcomes underscore a simple truth: appropriate technology when matched to context saves lives.
Innovation does not need to be complex. One of the most persistent challenges in managing PPH is the delay in recognizing it is happening. Visual estimation of blood loss is unreliable. Introducing simple, reusable blood-collection drapes enables objective measurement, earlier diagnosis, and faster escalation of care will result in faster escalation. Timely action is critically important and often the difference between life and death.
Equally important is combination therapy. The co-ordinated use of uterotonics, tranexamic acid (TXA), and misoprostol, delivered according to clear protocols, has proven effective in reducing mortality. When such interventions are embedded into national Essential Medicines Lists, availability improves, procurement increases, and lives are saved. Policy decisions directly translate into clinical outcomes.
Training and task-sharing are also indispensable. Health workers at all levels, including those in primary and community settings, must be empowered to act decisively. Community-based providers, when properly trained and supported, can administer life-saving medications safely and appropriately. Controversy around certain drugs should not impede access when evidence clearly supports their use to prevent maternal death.
PPH cannot be addressed in isolation. Anemia, hypertensive disorders, and poor nutritional status significantly increase the risk of severe bleeding and death during childbirth. Preventing PPH therefore requires a continuum-of-care approach—one that includes antenatal nutrition, micronutrient supplementation, and early identification and management of high-risk conditions such as preeclampsia.
In Makueni County, we are proud to have achieved a significant milestone: zero maternal deaths from postpartum hemorrhage in public health facilities in both 2023 and 2024, through an approach that places women’s lives firmly as a political priority. At its core, PPH exposes how much societies value women. In most households, women are the central pillar, sustaining families, economies, and communities. Allowing them to die from preventable causes during childbirth is indefensible.
Ending preventable death from PPH demands more than guidelines; it requires political will, sustained investment, and accountability. Policymakers must be brought into the room, confronted with the evidence, and compelled to act. Maternal survival should not depend on geography, income, or luck.
The question is not whether we know how to stop women dying from PPH—we do. The question is whether we are willing, collectively and politically, to decide that women’s lives are worth saving.
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Free Access
Postpartum hemorrhage: Keeping sub‐Saharan Africa on the global table
by Ibrahima Teguete
First published: 17 March 2026 https://doi.org/10.1002/ijgo.70923Digital Object Identifier (DOI)
Postpartum hemorrhage (PPH) remains one of the clearest symbols of global inequity in maternal health. It is a condition that is largely preventable, often treatable, and yet continues to claim the lives of far too many women, particularly in sub-Saharan Africa. We do not need to be statisticians to understand the gravity of this reality; the numbers merely confirm what clinicians on the ground witness every day.
In many countries across sub-Saharan Africa, maternal mortality ratios remain unacceptably high, and PPH is a leading contributor. Whether a country reports 300, 400, or 500 maternal deaths per 100 000 live births, these figures all describe the same urgent crisis. They reflect health systems under strain, delayed access to care, shortages of trained personnel, and fragmented responses to obstetric emergencies.
The challenge of PPH is not a lack of knowledge. We know what works. Evidence-based antenatal care, skilled birth attendance, timely use of uterotonics, multidisciplinary teamwork, and rapid referral systems save lives. The challenge lies in implementation—bringing these interventions to the places where women are most at risk, and sustaining them in complex, resource-limited settings.
Experience from the field shows that progress is possible, even under difficult circumstances. In high-burden districts, locally led, multidisciplinary approaches—bringing together obstetricians, midwives, anesthesiologists, pediatricians, and social scientists—have demonstrated meaningful reductions in pregnancy complications and maternal deaths. Importantly, these gains have been achieved, not through short-term projects alone, but through commitment, adaptability, and the mobilization of young health professionals determined to change outcomes for their communities.
PPH cannot be addressed in isolation. It is embedded in a broader maternal health ecosystem that includes antenatal care, respectful maternity services, emergency preparedness, and postnatal follow-up. Political commitment is essential, but it must be matched by operational coherence on the ground. Holistic, people-centered care is not a theoretical concept—it is a practical necessity in real-world settings where delays and fragmentation cost lives.
This is why sub-Saharan Africa must remain firmly on the global agenda. Not as a footnote, but as a central focus of collective action. International dialogue, professional societies, and global congresses have a responsibility to amplify realities from the field and to foster genuine partnerships that translate commitments into sustained action and impact.
Addressing PPH is a shared responsibility. When we work together, across disciplines, countries, and institutions, we can move from acknowledging the problem to solving it. Women everywhere deserve the chance to survive childbirth. Keeping PPH, and the regions most affected by it, on the global table is not only a moral imperative; it is the path to real progress.
This is both a call and a pledge: to remain united, committed, and focused—until preventable maternal deaths from PPH are no longer accepted as inevitable.
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Free Access
Postpartum hemorrhage: Making maternal mortality history
by Pascale Allotey
Every second matters in postpartum hemorrhage (PPH). Every moment spent working in silos, disjointedly, or competing rather than collaborating is time that could have made the difference between life and death for a woman giving birth. Like maternal health at large, successfully treating and preventing PPH is a test of how well our global health community works together.
The joint launch of global guidelines for the prevention and treatment of postpartum hemorrhage by the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM) is a statement of shared responsibility and a commitment to do better. Developed over 18 months of rigorous collaboration, these guidelines translate research into practical, evidence-based tools designed and ready for real-world use.
For too long, fragmented guidance has slowed action at the bedside. The science of preventing and treating PPH is well understood. We have the evidence. We have the tools. We know what needs to be done. The effort to bring key players onto the same page, both literally and figuratively in order to end these preventable deaths was articulated in the global PPH roadmap published in 2023.
The joint effort of producing the consolidated guidelines demonstrates that alignment is powerful. By bringing together the collective reach and expertise of WHO, FIGO, and ICM, we show that when institutions work as one we can be more efficient and effective in achieving ambitious goals.
Implementation is where lives are saved or lost. Guidelines only fulfill their promise when they are used consistently, promptly and correctly. That responsibility does not rest with one organization or one profession alone. It belongs to governments that must prioritize maternal health, to health professionals who must act decisively, to health systems that must be prepared to respond without delay, and to funders, civil society, industry, women, and advocates who must demand and support change.
Postpartum hemorrhage is, above all, a race against time. Time to recognize bleeding. Time to act. Time to escalate care. Delays whether caused by unclear guidance, poor coordination or system failures cost lives. Well-designed, aligned guidelines that bring together global players and professional associations provide clarity and save time.
We have a collective responsibility to ensure that our health systems can move fast enough when PPH strikes. Women’s lives depend on it. The launch of these joint guidelines is an important step forward. What matters now is that we work together to ensure that every birth is safer and that preventable deaths from postpartum hemorrhage become a thing of the past.
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Free Access
Postpartum hemorrhage: A turning point for global action
by Anne-Beatrice Kihara, Frank Louwen, Olufemi T. Oladapo, Alison Wright
Postpartum hemorrhage (PPH) remains a leading and preventable cause of maternal death, disproportionately affecting women in sub-Saharan Africa, and South and Southeast Asia. At the 25th FIGO World Congress, the President’s Session focused on PPH, and marked a crucial gathering dedicated to tackling this urgent issue. Our guiding principle is simple: no woman should die from excessive bleeding after childbirth.
This special collection brings together five editorials developed from presentations delivered during the session, reflecting perspectives from community advocacy, clinical care, professional leadership, government action, and global policy. Together, they underscore a shared vision: PPH is preventable, treatable, and unacceptable as a cause of maternal death.
The statistics are stark. While the global maternal mortality ratio is approximately 197 per 100 000 live births, over 90% of deaths occur in low- and middle-income countries. Sub-Saharan Africa averages more than twice the global rate, with South Asia also facing a substantial burden. Neonatal mortality follows similar disparities, underscoring the urgent need for effective, timely interventions.
A major milestone highlighted during the session is the release of the joint WHO-FIGO-ICM guidelines on the prevention, diagnosis and treatment of PPH. These unified, evidence-based guidelines replace multiple fragmented documents and provides a clear, actionable framework for preventing and managing PPH worldwide (https://www.who.int/publications/i/item/9789240115637).
Guidelines alone, however, are not enough. Lives are saved when evidence is implemented, adapted to local contexts, and supported by strong health systems, trained personnel, and engaged communities. For PPH, every second counts—early recognition, prompt action, and rapid escalation of care are critical.
The editorials in this collection illustrate how collaborative, multidisciplinary approaches—from community engagement to health policy—can translate evidence into action. They reinforce a shared agenda: reducing preventable deaths caused by PPH to zero.
The session also marked the inauguration of World Postpartum Hemorrhage Day on October 5, 2025, as a day of remembrance, action, and solidarity. It reminds us that PPH is preventable and that every maternal death is a failure we have the power to prevent.
We invite readers to engage with this collection as a unified call to action. The knowledge exists. The tools exist. The responsibility lies with all of us—to act together, swiftly, and decisively—to ensure that every woman survives childbirth.
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Free Access
by Angela Nguku
Postpartum hemorrhage (PPH) remains the leading global cause of maternal mortality, disproportionately affecting women in low- and middle-income countries. In global policy arenas, the discourse typically centers on clinical metrics, guidelines, and technological interventions. Yet this focus continues to sideline the lived experiences of women who survive PPH, those who are bereaved, and those whose lives are permanently reshaped by it.
This article calls for a deliberate epistemic shift. A recognition of women’s voices as legitimate evidence, essential for shaping meaningful policy and improving care quality. Drawing on community insights from more than 20 million women and girls globally, including over 3.5 million women and girls in Kenya, this commentary outlines the human, social, and psychological consequences of PPH and calls for the global health community to adopt the Ask–Listen–Act Power model as a foundational practice.
PPH is more than a clinical emergency. It is a social, psychological, and generational crisis that devastates families and communities. While global maternal mortality statistics frequently anchor professional discourse, numbers cannot fully convey the lived reality of a woman who bleeds, fears, survives—or does not. Too often, the voices of those who experience PPH firsthand remain peripheral to the global maternal health agenda. Women are still positioned as passive recipients of care rather than authorities on what failed, what harmed, and what could have saved them.
The White Ribbon Alliance has spent decades working to elevate these voices, and over the past five years alone has listened to over 3.5 million women and girls in Kenya and more than 20 million globally. Their stories challenge technical complacency and policy inertia. They demand that maternal health be treated not as a narrow clinical issue, but as a human rights imperative rooted in dignity, equity, and justice. This editorial draws from those voices to re-center maternal health as a human rights imperative.
1. THE HUMAN COST BEHIND THE STATISTICS
Women’s experiences of PPH point to a crisis that extends beyond morbidity and mortality. PPH survivors often carry lifelong trauma, shaped not merely by the physical event but by inadequate communication, delayed care, and the emotional abandonment they experience at their most vulnerable moment. Many recount being dismissed, blamed, or told their alarming symptoms were “normal”.
One adolescent mother’s experience illustrates this clearly. At 17, Sylvia attended all recommended antenatal visits, followed clinical guidance, and delivered in a health facility. Yet when she began to bleed, her concerns were dismissed. She collapsed alone. No one explained what was happening to her body. She learned the term postpartum hemorrhage months later. Her experience is not exceptional—it is emblematic.
The emotional toll of such encounters is profound. Survivors describe:
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debilitating fear of future pregnancies,
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persistent anxiety,
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shame reinforced by social stigma,
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a sense of betrayal by health systems meant to protect them.
PPH is therefore not only an obstetric emergency. It is a dignity crisis, an economic crisis and a justice crisis.
A dignity crisis, because too many women bleed in silence. They are not believed when they raise alarm. They are not informed about what is happening to their bodies. They are left afraid, confused and alone at the very moment they need care, clarity, and reassurance. No woman should survive childbirth feeling invisible, blamed, or dismissed.
An economic crisis, because the cost of surviving PPH is often borne by families least able to afford it.
Emergency transport is paid for in cash. Livestock is sold. Savings are wiped out. Work is lost. For women who survive, recovery can mean weeks or months without income. Survival comes with debt, dependence and long-term economic setback. When a woman dies, poverty deepens and spreads across households and generations.
A justice crisis, because preventable harm persists in systems that know what works but fail to act with urgency, equity and respect. Because women’s voices are still treated as secondary to protocols. Because accountability weakens where power concentrates. A system that saves a woman’s life while stripping her of dignity, security, and voice has not delivered justice.
2. FAMILIES AND COMMUNITIES BEAR THE HIDDEN BURDEN
When a woman dies, an entire family system fractures. Children grow up without mothers. Grandparents—often elderly—are thrust back into caregiving roles. Husbands speak of lifelong grief and economic instability. Communities lose educators, farmers, leaders, and caregivers. These cascading effects rarely appear in demographic surveys, yet they shape community wellbeing for generations.
By contrast, when a woman survives but is traumatized or physically weakened, the consequences are quieter but equally enduring. Survivors frequently report:
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undiagnosed postpartum mental health conditions,
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long-term distrust of healthcare providers,
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financial strain linked to emergency care and transport,
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social isolation.
These harms compound over time, reinforcing cycles of poverty and gender inequity far beyond the moment of birth.
3. RECONCEPTUALIZING EVIDENCE: EVERY STORY COUNTS
Traditional health systems privilege quantitative data—incidence, mortality ratios, drug efficacy—over qualitative evidence such as lived experience. Yet for millions of women, experiential evidence is the only data that captures their reality.
The Ask–Listen–Act Power model provides a corrective framework:
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Ask women what they need and what they experienced.
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Listen without dismissing or reframing their perspectives.
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Act by integrating their priorities into policy, funding, programming, training, and accountability mechanisms.
This model reframes patient engagement from a tokenistic gesture to a foundational research and policy methodology. This is participation as power not a mere consultation.
4. A GLOBAL CALL TO ACTION
If global actors are serious about ending preventable PPH deaths, women’s voices must be treated as authoritative not optional. Policymakers, programmers, clinicians, and professional societies must urgently commit to:
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embedding community voices into national maternal health policy processes,
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investing in qualitative research and participatory methods,
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ensuring that every woman understands PPH risk and symptoms,
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improving respectful maternity care and communication practices,
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integrating survivors’ insights into training curricula.
Evidence shows that effective clinical interventions exist. What is missing is system responsiveness and a cultural shift towards respectful, woman-centered care.
5. CONCLUSION
PPH persists, not because effective interventions are unknown, but because health system constraints and execution gaps continue to limit timely, respectful, and high-quality care, and because women’s realities remain peripheral to decision making. Women’s experiences provide practical evidence of what fails, what causes harm, and what must change across the care pathway from early recognition and decision making to referral, transport, and facility-based response. Centering women’s voices is essential to maternal health care practice because it strengthens trust, responsiveness, and accountability. Addressing preventable maternal deaths will require clinical excellence and policy action matched with locally informed leadership and sustainable system-level change grounded in women’s lived experience.
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Postpartum hemorrhage: From preventable death to collective action
https://doi.org/10.1002/ijgo.70927
Postpartum hemorrhage (PPH) remains one of the most devastating and preventable causes of maternal death worldwide. Despite decades of evidence, interventions, and global commitments, women continue to die during and after childbirth from bleeding that could have been anticipated, recognized, and treated. This reality is no longer acceptable.
Behind every death from PPH is not only a statistic, but a woman, a newborn, and a family whose future has been irreversibly altered. Children grow up without mothers. Partners and communities bear enduring loss and fear. The persistence of these deaths, particularly when they are preventable, does not reflect a lack of evidence, but a failure to implement what we already know to save lives.
The evidence is unequivocal. When women receive care from educated, regulated midwives working within functioning health systems, supported by clear referral pathways to obstetricians, gynecologists, neonatologists, and pediatricians, lives are saved. This is affirmed by the World Health Organization (WHO), the International Confederation of Midwives (ICM), and the International Federation of Gynecology and Obstetrics (FIGO). It is neither complex nor controversial; it is fundamental to safe maternity care.
Over the past 18 months, the global maternal health community has been equipped with an unprecedented set of tools to translate evidence into practice. Three key documents mark a turning point:
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The WHO transition paper on implementing midwifery models of care
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The Midwife Accelerator, which provides a compelling case for scaling these models at health-system and ministry levels
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The practical implementation guide for midwifery models of care
Together, they move the conversation beyond aspiration to action.
These resources are not about professional territory or self-interest. They are about doing the right thing for women and newborns. They reflect the realities of frontline care: midwives as first responders, required to act decisively, knowing what to do, when to do it, when to consult, and when to refer. They also acknowledge the constraints common in low-resource settings: unreliable procurement, lack of essential medicines, inadequate cold-chain storage, fragile transport systems, and environments where infrastructure can fail without warning. Yet even in these contexts, timely, skilled care can determine survival.
PPH cannot be addressed by isolated guidelines alone. Guidance has impact only when operationalized, when health workers are trained, supplies are available, referral pathways function, and systems enable rapid response. Implementation tools make guidance actionable, but outcomes are ultimately shaped by decisions made in clinics, labour wards, and communities.
Crucially, preventing death from PPH is about more than survival. Women and newborns should leave care not only alive, but with the opportunity to thrive. The long-term consequences of poorly managed childbirth, severe morbidity, infection, neurological injury, are reminders that quality of care matters as much as access to care.
Equity must be central to this effort. A woman’s place of residence should never determine her chance of surviving childbirth. Every woman, every newborn, everywhere, every time, must receive safe equitable care. This must be the standard by which health systems are judged. Women matter. Newborns matter. Families and societies depend on their survival and wellbeing.
Ending preventable deaths from postpartum hemorrhage demands shared leadership, humility, and a sustained commitment always placing women and newborns at the centre of care.
The launch of new guidance and implementation tools is not the culmination of this work; it is the beginning. Years from now, the measure of success will not be which documents were published, but what actions were taken. If we are serious about ending preventable deaths from postpartum hemorrhage, now is the moment to move decisively, from evidence to implementation, and from commitment to impact. The impact of what we do now will ripple through generations.