Silent killer: Postpartum bleeding still claims ten mothers every day

Eunice Atsali patient of overbleeding after birth, during the interview at her home in Ruai on 17,June,2025. [ Jenipher Wachie, Standard] When Eunice Atsali walked into Kenyatta National Hospital (KNH) to deliver her second child, she was filled with excitement, ready to welcome her baby. Nothing, however, could have prepared her for the ordeal that followed. A seasoned midwife, a lecturer at Kenyatta University, and an advocate for maternal health, Atsali was well-versed in childbirth; she had assisted countless mothers deliver safely. But this time, she was the patient. Her Caesarean section (CS) was elective and planned. Having delivered her first child via CS without complications, she expected a routine procedure. "I thought it would be straightforward," she recalls. But shortly after waking from surgery, something felt wrong. A sharp pain gripped her abdomen. "I found myself lying in a pool of blood," she says. "My instincts kicked in-I knew I was bleeding heavily. I quickly alerted a nurse." The nurse had already noticed her blood pressure dropping. Blood was pouring out, accompanied by large clots. Atsali knew something was gravely wrong. Her mind raced. She had studied Postpartum Haemorrhage (PPH) in textbooks, taught it in classrooms, and managed it in patients, but now, she was living the nightmare herself. Her uterus was failing to contract, and worse, her blood was not clotting properly. Doctors rushed to save her life. She received six units of whole blood and four units of fresh frozen plasma to replace the massive blood loss. Medications were injected directly into her uterus, alongside manual compression, in an urgent effort to stimulate contractions. The mention of Disseminated Intravascular Coagulation (DIC) sent a chill down her spine. Doctors discussed removing her uterus-a terrifying prospect, but the threat of death was even more daunting. "I sensed death at the mention of DIC," Atsali recalls. "I was anxious. I pleaded with a nurse to bring my baby before I slipped into unconsciousness. I had seen women die from it. Hearing it in my case, I thought it could be the end." Her husband, in shock, called a relative to break the news, uncertain if she would survive. Atsali survived-barely. She experienced excessive bleeding, thirst, dizziness and fainting. "I escaped death by a whisker. I had never seen anyone survive DIC. The only case I handled ended in the woman's death. I'm grateful KNH was prepared with blood, medicines and skilled doctors. If any of those had been missing, I wouldn't be here," she says. Her knowledge of PPH enabled her to recognise early signs. "Had I not identified them, I could have been found dead," she adds. The experience transformed Atsali, who vowed to become a voice for PPH awareness. As the National Secretary for the Midwives Association of Kenya and a co-principal in the End PPH Consortium, representing the University of Nairobi, the Kenya Obstetrics Gynaecology Society, and the Midwives Association of Kenya, she champions policies to improve PPH management. She trains healthcare providers and advocates for better-equipped facilities. "I was a near miss, but many are not as lucky. We can-and must-change that," she says with optimism. Atsali's story reflects the fragility of maternal health systems in Kenya, where thousands of women face PPH. Every day, an average of 10 women die from excessive bleeding after childbirth. Kenya's maternal mortality rate stands at 352 deaths per 100,000 live births, resulting in 6,000 to 8,000 women losing their lives annually to preventable pregnancy-related complications. The five leading causes of maternal deaths in Kenya are PPH, pre-eclampsia, obstructed labour, infections like sepsis and complications from unsafe abortions. In 2023, Sub-Saharan Africa accounted for 70 per cent of global maternal deaths, with 130,000 women dying from pregnancy-related complications. "About 6,000 women die annually in Kenya due to pregnancy-related complications, with PPH causing 40 to 60 per cent of these deaths," says Dr Juliet Omwoha Auma, Head of Newborn and Child Health at the Ministry of Health. PPH also impacts newborn survival. Kenya's neonatal mortality rate is 21 deaths per 1,000 live births. "When a mother experiences PPH, the newborn's health is compromised, especially in the immediate postnatal period when the mother is too weak to care for the baby," Dr Auma explains. The top three causes of neonatal deaths are prematurity, birth asphyxia and sepsis. Data shows that 92 per cent of neonatal deaths are directly linked to the mother's health. "Prematurity and birth asphyxia are strongly tied to the mother's health and the quality of care she receives during pregnancy, delivery and postpartum," Dr Auma adds. "As we work to reduce maternal and neonatal deaths, we say, "Every heartbeat matters. Every breath counts. No mother should suffer in silence," she emphasises. Kenya is striving to meet the UN's Global 90-90-80-80 targets: 90 percent of women attending antenatal care (up from 66 percent), 90 percent of births attended by skilled health workers, 80 percent of mothers and newborns receiving postnatal care within 48 hours, and 80 percent of the population accessing sick and small newborn care units and emergency obstetric care. To achieve this, the Ministry of Health is strengthening referral systems for timely access to quality care. Community Health Promoters (CHPs) are being trained to identify danger signs in mothers and newborns, refer cases, and guide families to equipped facilities. The Ministry has also invested in building healthcare workers' capacity in emergency obstetric and neonatal care (EmONC). Health workers in maternity and newborn units are now equipped to manage complications like PPH and prematurity. Neonatal units are stocked with essential supplies, such as caffeine to aid premature babies' breathing, and Continuous Positive Airway Pressure (CPAP) machines for respiratory support. Innovations like breast milk banks have further improved newborn immunity and reduced infections. However, challenges persist. The recent freeze in foreign aid, particularly from the US, has strained maternal and child health programmes. In the 2025/26 financial year, maternal, newborn, and adolescent health received Sh16.9 billion, an amount experts deem insufficient. "Kenya faces sustainability gaps. Funding for interventions often runs out, halting progress," says Prof Moses Obimbo, a gynaecologist. Dr Laura Oyiengo, Maternal and Newborn Health specialist at UNICEF Kenya, notes that while many facilities are equipped to manage deliveries and emergencies, stockouts of essential medicines like uterotonics, delays in blood supply, and slow replenishment of critical commodities remain challenges. Counties face varying issues, from leadership to geography, affecting maternal and newborn health outcomes. "Our focus is ensuring immediate help, available supplies and seamless referrals when a mother starts bleeding," says Dr Oyiengo. Prof Obimbo, Chairman of Human Anatomy and Medical Physiology at the University of Nairobi and a Calestous Juma Science Leadership Fellow, stresses that poor maternal health reflects broader health system failures. He calls for increased government resources to safeguard women's lives. "Delays in reaching hospitals due to poor infrastructure and delays in receiving care are costing lives," he says. He advocates for collective responsibility, involving chiefs, village elders, health workers, MPs, governors, and the President to ensure women receive proper care throughout their maternal journey. The University of Nairobi, alongside the Kenya Association of Gyneacologists and Obstetricians and the Midwives Association of Kenya, leads the "End PPH Initiative" to reduce PPH deaths by at least 5per centnt.

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