Across Africa, the fight to keep mothers alive during childbirth is finally showing signs of progress. Governments are investing in stronger maternal health systems, introducing evidence-based treatment guidelines and expanding emergency obstetric care.
Countries such as Rwanda, Uganda, Kenya and Nigeria have all recorded declines in maternal mortality over the past two decades. Yet behind these gains lies a stubborn challenge threatening to reverse progress: teenage pregnancy.
At the inaugural International Postpartum Haemorrhage (PPH) Conference in Nairobi, obstetricians, researchers and policymakers from across Africa voiced a shared concern that reducing maternal mortality will be impossible unless governments tackle the growing burden of teenage pregnancies alongside strengthening emergency obstetric care.
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According to the World Health Organisation, Postpartum haemorrhage (PPH) is severe bleeding after childbirth, blood loss of 500 ml or more within 24 hours after birth.
Uganda is among the countries demonstrating measurable progress. Yet, despite these gains, teenage pregnancy remains one of Uganda's biggest public health challenges.
"Our teenage pregnancy rate is around 24 per cent. Adolescents are biologically, socially and economically more vulnerable. They are more likely to experience complications during childbirth, including postpartum haemorrhage, while many also resort to unsafe abortions. Unless we intentionally reduce teenage pregnancies, reducing maternal mortality will remain difficult," said Dr Kayondo Simon Peter, Vice President of the Association of Obstetricians and Gynaecologists of Uganda.
Uganda’s maternal mortality ratio has fallen over the last two decades, from more than 500 deaths per 100,000 live births in 2000 to about 189 deaths per 100,000 live births in 2022.
The reduction, he says, is the result of deliberate investments in evidence-based interventions, updated clinical guidelines, improved antenatal care, stronger referral systems and continuous training of health workers.
"In 2020, postpartum haemorrhage contributed about 45 per cent of maternal deaths in Uganda. Today, preliminary estimates indicate it contributes roughly 34 per cent. It is still our leading cause of maternal death, but the proportion continues to fall," he said.
Uganda has adopted the World Health Organisation's updated PPH guidelines, introduced the E-MOTIVE treatment bundle, strengthened emergency obstetric care and expanded free access to lifesaving medicines including tranexamic acid, heat-stable carbetocin and oxytocin in public facilities.
WHO estimates that postpartum haemorrhage accounts for about 27 per cent of all maternal deaths globally, with the greatest burden falling on low- and middle-income countries, particularly in sub-Saharan Africa.
More than 70,000 women die every year from excessive bleeding after childbirth, despite the condition being largely preventable and treatable through timely diagnosis, skilled care, blood transfusion and lifesaving medicines.
According to UNICEF, sub-Saharan Africa remains the region with the world's highest adolescent birth rate. Millions of girls become pregnant before the age of 18 each year, exposing them to significantly higher risks of obstetric complications, including postpartum haemorrhage, obstructed labour, pre-eclampsia and maternal death.
UNFPA further estimates that complications during pregnancy and childbirth remain among the leading causes of death for girls aged 15 to 19 globally, with the overwhelming majority occurring in low-income countries.
Neighbouring Rwanda has achieved one of Africa's most remarkable declines in maternal mortality.
According to Dr Victor Mivumbi, President of the Rwanda Society of Obstetricians and Gynaecologists, the country's maternal mortality ratio has declined from about 1,071 deaths per 100,000 live births in 2000 to approximately 149 per 100,000 live births, according to the 2025 Rwanda Demographic and Health Survey.
He attributes the progress to sustained government investment in health infrastructure, universal community health insurance, expanded access to skilled birth attendants and innovative technologies.
Among Rwanda's most celebrated innovations is the use of drones to deliver blood products to remote health facilities.
"In cases of postpartum haemorrhage, every minute counts. Through drone delivery, blood can reach facilities within 20 to 30 minutes. That has transformed emergency response," Dr Mivumbi explained.
However, he expressed concern over rising teenage pregnancies.
"Teenage pregnancy has increased from around five per cent to seven per cent. These pregnancies contribute significantly to maternal complications, including postpartum haemorrhage."
To address the challenge, Rwanda revised its reproductive health policy, allowing adolescents aged 14 years and above to access contraception while expanding sex education and community awareness programmes.
Nigeria, home to one of the world's highest maternal mortality burdens, is also implementing major reforms.
Naanma Kangkum, Maternal Health Programme Manager at Solina Centre for International Development and Research, says postpartum haemorrhage remains responsible for roughly one in every five maternal deaths in Nigeria.
Government reforms have introduced national PPH treatment guidelines, expanded provider training, improved access to heat-stable carbetocin and rolled out the E-MOTIVE package in selected facilities.
Nigeria has also launched the MAMI programme, targeting local government areas with the highest maternal mortality burden through better emergency referrals, free obstetric care and expanded ambulance services.
Yet more than half of births in Nigeria still occur at home.
"Many women cannot afford care, live too far from health facilities or have previously experienced poor-quality treatment. Delays in seeking care remain one of our biggest challenges," Kangkum said.
He added that nutrition during pregnancy, early prevention of anaemia, objective measurement of blood loss using calibrated drapes and rapid treatment using bundled interventions remain among the most effective ways to reduce postpartum haemorrhage.
Kenya, meanwhile, continues to grapple with one of the region's highest maternal mortality ratios.
Speaking at the conference Prof Moses Obimbo, founder of the End PPH Initiative, postpartum haemorrhage contributes between 40 and 50 per cent of maternal deaths in Kenya, translating to an estimated 2,000 to 3,500 preventable deaths every year.
According to the Ministry of Health, maternal mortality in Kenya claims approximately 16 women every day, with PPH as the leading cause of death, accounting for 40 per cent of maternal deaths. Other major causes include high blood pressure during pregnancy, infections, unsafe abortions, and delays in accessing emergency medical care, particularly in rural and underserved areas.
Kenya’s maternal mortality rate is 355 deaths for every 100,000 live births, a figure that translates to approximately 6,000 preventable deaths every year.
While Kenya has introduced better uterotonic medicines, strengthened provider training and embraced updated WHO recommendations, significant gaps remain.
"We have made progress, but we have not employed enough skilled health workers. We have trained many midwives and doctors, but deployment remains a challenge. Access to blood products also remains inconsistent," said Prof Obimbo.
Teenage pregnancy, he added, compounds the crisis.
"In Kenya, about 250,000 of the country's roughly 1.2 million annual pregnancies occur among teenagers. These young mothers experience poorer outcomes because their bodies are still developing. They are also less likely to access health insurance or quality maternity care."
In Kenya, twenty-six counties have been identified as high-burden areas for maternal and newborn mortality: Garissa, Mombasa, Kisumu, Kisii, Kitui, Nairobi, Machakos, Nakuru, Trans Nzoia, Bungoma, Homa Bay, Kwale, Siaya, Kilifi, Kakamega, Kajiado, Uasin Gishu, Meru, Samburu, Elgeyo Marakwet, West Pokot, Tana River, Turkana, Mandera, and Wajir.
With only a few years remaining to achieve Sustainable Development Goal 3, reducing global maternal mortality to fewer than 70 deaths per 100,000 live births by 2030 experts say incremental progress will no longer be enough.
"Africa must move from discussion to acceleration," Prof Obimbo said. "Every preventable maternal death represents a failure of the health system. We already know what works. The challenge now is ensuring every woman, regardless of where she lives or how old she is, can access those lifesaving interventions before it is too late."