05 · Start Before Birth · Prevention and anaemia

The risk is set

before labour begins.

The previous four pages explained how to respond when a woman haemorrhages. This page focuses on prevention: actions a health system can take prior to a woman entering a labour room.

The problem in brief

Anaemia influences a woman’s ability to withstand blood loss. This could be due to compensatory increases in cardiac output, placental size and vascularity; reductions in the oxygen carrying capacity of blood, compromising myometrial contractility; and impaired blood clotting [1]. In addition to this, a woman in labour with severe anaemia already starts with diminished reserves. As a result: the average 400 mL blood loss tolerated by a woman with normal reserves can become critical for a woman with severe anaemia.

Most pregnancy-related anaemia is due to iron deficiency, which is detectable and treatable well before labour, making the risks above preventable [1]. This page elaborates how anaemia can be prevented antenatally.

The Risk

Anaemia increases the risks and effects of postpartum haemorrhage: women with anaemia face a 2.4-fold higher risk of death [1] [4] [5]. For survivors, the relationship does not end there; severe anaemia delays recovery and compounds the risk of future pregnancies [2]. Left unaddressed, the cycle continues throughout a woman’s reproductive life.

The Scale

37% of pregnant women worldwide are affected by anaemia, with the highest rates in Africa and Asia [1]. The burden falls heaviest where deaths from postpartum haemorrhage are concentrated and where blood for transfusion is scarcest [1] [2].

The Solution

Among all risk factors for postpartum haemorrhage, anaemia holds a key place in guidelines as it can be easily identified and managed at low cost. Detection involves measuring haemoglobin, and treatments for anaemia can include:

  • iron and folic acid supplements
  • intravenous iron
  • blood transfusion
  • management of heavy menstrual bleeding
  • and control measures for malaria and hookworm in areas with high prevalence [1] [3].

The Policy

The consequences of leaving anaemia untreated reach beyond the woman herself, potentially reducing her capacity to work and care for her children [1].

Detecting and treating anaemia is therefore a strong choice for a ministry deciding where its maternal health budget should be directed.

The wider prevention package

Preventing anaemia from developing is also key to the wider postpartum haemorrhage prevention package. Prevention involves the following set of measures [1] [3]:

Uterotonic prophylaxis

Uterotonic prophylaxis

Misoprostol plus oxytocin was ranked highest as the most effective. Followed by ergometrine plus oxytocin [1] [3].

Offer contraception

Offer contraception

18.0% of women in sub-Saharan Africa face an unmet need for contraception, compared to only 3.5% in western Europe [1].

Avoiding unnecessary caesarean sections

Avoiding clinically unnecessary caesarean sections

As well as increasing the risk of haemorrhage, caesarean sections increase the risk in future pregnancies of placenta accreta spectrum (abnormal placenta location) [2].

Preventing placenta accreta spectrum

Preventing placenta accreta spectrum

where caesarean scars cause the most severe postpartum haemorrhage of all. [1] [2].

References

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

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

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