The World Health Organization (WHO) has released its first roadmap to tackle excessive bleeding after childbirth known as postpartum haemorrhage (PPH). PPH affects millions of women annually and is the leading cause of maternal death worldwide.
Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said of the launch: “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 WOMAN Trials aim to ensure a safe childbirth for women everywhere by evaluating the effects of the drug tranexamic acid (TXA) on PPH. In 2017, the WOMAN Trial showed TXA was a lifesaving treatment for PPH; the first treatment proven to cut PPH deaths. The WOMAN-2 Trial is investigating whether TXA can prevent PPH in women with anaemia, since anaemia greatly increases the risk of PPH. The trial has recruited 15,000 women giving birth vaginally in four countries: Nigeria, Tanzania, Zambia and Pakistan. The results will be published in 2024.
To ensure that TXA is available for all women with PPH wherever they are, Amy Brenner is leading the I’M WOMAN Trial, which aims to find easier ways to give TXA, said: “We’re happy to have fed directly into the WHO roadmap, which prioritises research on TXA for PPH prevention and alternative routes of TXA administration. We are investigating both of these through the I’M WOMAN trial, part of the TRANSFORM project funded by Unitaid, which aims to expand equitable access to TXA. PPH results in around 70,000 maternal deaths every year. We need strong collaboration and action to ensure women have access to this lifesaving drug wherever they give birth.”
The PPH roadmap outlines goals and activities for research, implementation and advocacy – milestones can also be tracked through an accountability site. It aims to help countries address stark differences in survival outcomes from PPH, reflecting major inequities in access to essential health services, as over 85% of deaths from PPH happen in sub-Saharan Africa and South Asia.
PPH risk factors like anaemia, deserve far more attention. Dr Ian Roberts, Professor of Public Health at LSHTM, said: “Bleeding after childbirth kills one woman every six minutes and anaemia greatly multiplies the risk of bleeding and death. Worldwide, half a billion women are anaemic and 20 million are severely anaemic. Anaemia prevention is urgently needed to cut PPH deaths. We need changes in policy and practice.”
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 tranexamic acid.
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, said: “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.”