27 million women.
43,000 deaths.

Once every 12 minutes.

Burden of postpartum haemorrhage

27M

Women every year

17M

Vaginal births

10M

Caesarean births

25%

of maternal deaths

43K

Deaths a year

Most of these deaths are preventable.

Unequal burden of PPH

About 90% of deaths occur in two main regions: sub-Saharan Africa (around 74%) and central and southern Asia (about 16%) [1]. The case fatality can be more than 200 times higher in low- and middle-income countries when compared to high-income countries, primarily due to factors such as untreated anaemia, no access to quality drugs, unavailability of blood transfusion facilities, and lack of timely escalation and referral pathways [1].

>200×

Inequity in survival [1]

Two world maps on the same 0 to 30 percent scale. Left, in blue: PPH cases by region, spread across South Asia and sub-Saharan Africa. Right, in red: PPH deaths, concentrated almost entirely in sub-Saharan Africa and central and southern Asia.

Modelled estimates for 2023 · Lancet PPH Series, Paper 1

The cost

Postpartum haemorrhage costs countries, health systems, and families approximately US$10.4 billion annually [1]. The burden of emergency surgery, need for blood transfusion, intensive care, lost economic output, and extended recovery hit the hardest on those economies with the least capacity to absorb these costs. This underscores that prevention, early detection and treatment of postpartum haemorrhage using an evidence-based treatment bundle are the priority in low- and middle-income countries [1].

$10 B

Cost every year, US dollars [1]

The lasting impact of postpartum haemorrhage

Survival following postpartum haemorrhage does not mark the end of its clinical implications. Severe anaemia is a serious consequence: about 46% of survivors are left anaemic after childbirth, which can hamper recovery and reduce the woman’s ability to return to routine life [1]. The other consequences of postpartum haemorrhage include, emergency hysterectomy, organ failure, and long-term psychological trauma [1].  While the number of deaths highlights part of the burden, it underestimates the ongoing impact on survivors and their families.

46 %

of survivors are left anaemic[1]

Why women die from PPH – Four missed opportunities

A woman with untreated anaemia goes into labour. After labour, her blood loss is visually underestimated and recorded as normal. As her pulse increases, treatment starts gradually, with each intervention arriving after the previous one at variable time intervals.

Her journey intersects four critical points.

1  PREGNANCY

Now: Her anaemia is undiagnosed and untreated. Her reserve is already low before labour sets in.

Intervention: Finding and treating anaemia during pregnancy, through haemoglobin checks and iron treatment, builds the reserve she will need if she haemorrhages [1] [2].

2  BIRTH

Now: She doesn’t always receive medicines to prevent PPH.

Intervention: A uterotonic for every woman at every birth, oxytocin or heat-stable carbetocin where available, misoprostol where they are not, stops most bleeding before it starts [2] [4].

3  AFTER LABOUR

Now: Her blood loss is estimated and recorded as normal. Her pulse is rising, but with no clear threshold, the team watches and waits.

Intervention: A calibrated drape replaces the estimation with an objectively measured number the whole team can read. Using a calibrated drape and a defined trigger, measured blood loss plus one vital sign tells the team when to act. [3] [4].

4  PPH RESPONSE

Now: Treatment starts gradually: one intervention at a time, each arriving a little too late, compounding the blood loss.

Intervention: A bundled first response, uterine massage, uterotonics, tranexamic acid, intravenous fluids and examination for the cause, started together, so treatment is never behind the bleeding [3].

We now have the evidence to change the outcome

The following pages present evidence on resolving the current limitations in PPH detection and treatment for healthcare systems:

  • Prevention of postpartum haemorrhage before labour, measuring blood loss objectively following vaginal birth, trigger criteria for initiating first response to postpartum haemorrhage, escalation when initial measures fail.
  • Robust evidence supporting this: the key E-MOTIVE trial involved 80 hospitals across Kenya, Nigeria, South Africa, and Tanzania [1] [3].
References

[1]  Coomarasamy A, Sindhu KN, Gallos I, et al. Postpartum haemorrhage: epidemiology, consequences, and missed opportunities. The Lancet, 2026. Paper · DOI

[2]  Gallos ID, Sindhu KN, Yunas I, et al. Prevention of postpartum haemorrhage: from evidence to implementation at scale. The Lancet, 2026. Paper · DOI

[3]  Gallos I, Devall A, Martin J, et al. Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage (E-MOTIVE). New England Journal of Medicine, 2023;389:11–21. Paper · DOI

[4]  WHO, FIGO, ICM. Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage, 2025. Paper