For a Kenyan woman who has survived nine months of pregnancy and delivered a baby safely, the danger should be over.
But for some mothers, severe bleeding after childbirth can turn a moment of joy into a life-threatening emergency within minutes.
Postpartum haemorrhage (PPH), or excessive bleeding after childbirth, remains the leading cause of maternal deaths in Kenya.
The Ministry of Health says PPH accounts for between 25 and 45 per cent of maternal deaths.
Kenya’s maternal mortality ratio stands at 355 deaths per 100,000 live births, according to the Ministry, underscoring the continuing challenge of preventing deaths that are often treatable.
Globally, the World Health Organisation (WHO) identifies severe bleeding, particularly bleeding after childbirth, as one of the leading causes of maternal deaths.
WHO estimates that about 260,000 women died during or following pregnancy and childbirth in 2023.
The danger with PPH is its speed. A woman can deteriorate rapidly, making early detection, skilled care, lifesaving medicines and access to blood essential.
“Postpartum haemorrhage is the most dangerous childbirth complication since it can escalate with such alarming speed,” WHO Assistant Director-General Dr Jeremy Farrar said in 2025 as WHO and its partners issued updated recommendations on PPH.
For Kenya, experts say preventing these deaths must begin well before a woman enters the delivery room.
Professor Anne Beatrice Kihara says some women reach the labour ward already anaemic, leaving them particularly vulnerable if they suffer heavy bleeding.
Kihara is a Consultant Obstetrician-Gynaecologist, Senior Lecturer at the University of Nairobi, and the immediate former President of the International Federation of Gynaecology and Obstetrics (FIGO).
“PPH, put simply, is the mother’s bleeding after childbirth, and there are many reasons for that. One, and the commonest, is really the lack of enough blood when she gets to the labour room,” Kihara said.
She says prevention must begin before pregnancy through pre-conception care, nutrition and treatment of conditions that can contribute to anaemia.
Kihara cites malaria, tuberculosis and HIV, as well as infections, parasitic worms and illnesses associated with poor water and sanitation, as factors that can affect a woman’s health and increase vulnerability to anaemia.
Maternal anaemia is also an important risk factor, and WHO recommends iron and folic acid supplementation during pregnancy.
For women who need rapid correction or cannot tolerate or respond adequately to oral iron, WHO recommends consideration of intravenous iron.
Kihara also highlights the importance of birth spacing.
“Ideally, a woman should wait 24 months. Often, that does not happen. So she gets pregnant when her body has not even recovered from a past pregnancy,” she said.
Early antenatal care is another critical intervention. Kenya is moving towards eight antenatal contacts during pregnancy, but Kihara says increasing the number of recommended visits will have limited impact if women cannot access the services.
“The reality is, if I can’t even make the four, how else can I get the care?” she said.
For women in remote communities, barriers include transport costs, long distances, limited emergency services and lack of information about when a pregnancy has become dangerous.
Kihara says mobile phones and telemedicine could help bridge some of those gaps by providing health information and connecting women to health workers.
“Health literacy is critically important,” she said, calling for information to be delivered in languages communities can understand.
Dr Edward Serem, head of the Division of Reproductive and Maternal Health at the Ministry of Health, says Kenya records between 1,000 and 1,500 maternal deaths annually from pregnancy and childbirth complications.
“Of all these, PPH is the leading cause of deaths in our country,” he said.
Serem identifies lack of knowledge and delayed referrals as major contributors to maternal deaths.
“Most of the deaths which are being reported are reported in the healthcare facilities. So when we analyse the reasons why mothers die, one is a lack of knowledge and two, delayed referrals,” he said.
Distance can make a referral a matter of life and death. A woman referred from a dispensary to a higher-level hospital may face a long journey, sometimes without reliable ambulance services.
Serem says some women still give birth while travelling to hospital.
The problem reflects delays at several stages of maternal care: recognising a complication, reaching an appropriate facility and receiving effective treatment once there.
In PPH, every delay matters.
WHO’s latest recommendations call for rapid recognition and treatment of postpartum bleeding. The recommended response includes uterine massage, medicines that help the uterus contract, tranexamic acid, intravenous fluids, examination to identify the source of bleeding and escalation of care where necessary.
WHO also recommends objective measurement of blood loss because visual estimates can underestimate the amount of blood a woman has lost.
But even when PPH is recognised and treatment begins quickly, some women require blood transfusions.
Professor Moses Obimbo of the University of Nairobi, who leads the PPH Initiative Run for Her, says blood shortages are a significant part of the problem.
“Out of 10 women that die because of postpartum haemorrhage, four of them died because they lacked blood,” Obimbo said.
His initiative has combined public awareness with a blood donation campaign targeting more than 2,000 units.
“We are approaching people, wherever they are, to donate blood,” he said.
The Ministry of Health has also been strengthening the national blood transfusion system.
Serem says the Directorate of Blood Transfusion is responsible for recruiting donors, processing blood and distributing it through regional blood banks.
“In this financial year alone, they have been given almost Sh1 billion to strengthen the availability of blood in our country,” he said.
However, experts say infrastructure and funding must be matched by a reliable pool of voluntary blood donors.
Blood is particularly critical in PPH because a mother can lose a large volume quickly. If compatible blood is unavailable, even a facility with trained staff, medicines and equipment may struggle to save her.
But blood availability is only one part of the solution.
Obimbo says health workers also need to be prepared for obstetric emergencies before they occur.
“In medicine, we wait until the emergency occurs. That’s when we are going into it,” he said.
He contrasts this with aviation and the military, where emergency drills and simulations are routine.
“If you go to the aviation industry, there is practice every day. There are simulations and people practice and prepare for emergencies,” he said.
His initiative is using virtual reality, gamification and telepresence mentorship to strengthen the skills and preparedness of healthcare workers in maternity and newborn units.
“We want to be very proactive before the emergency actually happens,” he said.
The Ministry is also investing in staffing, equipment, infrastructure, lifesaving commodities and training.
Serem says Kenya has deployed more than 100,000 community health promoters who help identify pregnant women, encourage antenatal attendance and link women to health facilities.
The government’s Every Woman Every Newborn Everywhere acceleration plan for 2026–2028 also includes measures aimed at improving maternal and newborn survival, including additional investment in maternal care, lifesaving commodities and the recruitment of nurses and midwives.
But the experts say interventions must reach women before complications become emergencies.
For a woman in a remote community, a national policy means little if there is no ambulance when she needs one. For a mother arriving at hospital with PPH, a trained health worker may be unable to save her if the facility lacks blood.
WHO stresses that PPH is not always predictable. Many women who develop severe bleeding have no obvious risk factors beforehand.
That makes preparedness essential.
Reducing maternal deaths therefore requires a functioning chain of care — from pre-conception and antenatal services to skilled delivery, rapid referral, emergency treatment and reliable blood supplies.
There is also a role for the public.
A person who donates blood may never know whose life that blood will save. But for a mother bleeding after childbirth, it could determine whether she returns home with her newborn or becomes another statistic in Kenya’s maternal mortality crisis.
“We cannot continue standing still when mothers are dying of preventable causes,” Obimbo said.
For Kenya, the fight against postpartum haemorrhage will require more than one intervention.
It will require healthier pregnancies, earlier care, better-equipped facilities, trained health workers, faster referrals, lifesaving medicines and enough blood available when mothers need it most.