By PPH Foundation
Air quality is increasingly being recognized as a critical but overlooked factor in maternal health, with direct implications for postpartum haemorrhage. Exposure to air pollution during pregnancy has been linked to conditions such as anaemia, hypertensive disorders, and reduced oxygen carrying capacity, all of which can increase a woman’s vulnerability to excessive bleeding during and after childbirth. In this way, clean air is not just an environmental issue, it is a determinant of how well a woman’s body can withstand and recover from blood loss.
Emerging evidence supports this connection. A study by Bekkar et al, 2020 found that exposure to fine particulate matter, PM2.5, during pregnancy is associated with increased risk of hypertensive disorders and adverse maternal outcomes. Similarly, research published in The Lancet Planetary Health indicates that air pollution contributes to systemic inflammation and impaired vascular function, factors that can complicate labour and increase the risk of postpartum complications, including haemorrhage. In low resource settings, where women may already face nutritional deficiencies, the combined effect of pollution and anaemia significantly heightens the risk of severe PPH.
Beyond risk, research also points to actionable solutions. Reducing exposure to indoor and outdoor air pollution, particularly from biomass fuels, has been shown to improve maternal health outcomes. The use of clean cooking technologies, improved ventilation in homes and health facilities, and broader environmental policies targeting emissions reduction are critical interventions. At the health system level, integrating environmental risk screening into antenatal care allows early identification of vulnerable women, while strengthening management of anaemia and hypertensive disorders reduces the likelihood of severe bleeding.
Evidence also supports the role of strengthened facility environments. Studies show that well ventilated, temperature controlled maternity wards improve maternal endurance during labour and reduce complications linked to physiological stress. Coupled with standard PPH response protocols, including timely administration of uterotonics and tranexamic acid, these measures significantly improve survival outcomes.
Reflecting on this, Prof Julius Ogengo, a Co-Lead at the End PPH Initiative, a project under the PPH Foundation notes that, “Maternal survival is influenced by more than clinical care alone. Environmental exposures, including the air a woman breathes, affect her physiology in ways that can either protect or endanger her during childbirth. Addressing these factors is essential in reducing preventable deaths.”
As the global conversation on environmental health continues, the link between clean air and maternal survival must not be overlooked. Protecting air quality, strengthening health systems, and addressing underlying vulnerabilities together form a comprehensive approach to reducing postpartum haemorrhage and ensuring safer motherhood.
Sources
Bekkar B, Pacheco S, Basu R, DeNicola N. Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight, and Stillbirth in the US, a systematic review. JAMA Network Open. 2020,3(6):e208243.
Zhang J, Mauzerall DL, Zhu T, Liang S, Ezzati M, Remais JV. Environmental health in China, progress towards clean air and safe water. The Lancet Planetary Health. 2019,3(11):e482–e492.
World Health Organization. WHO global air quality guidelines, particulate matter PM2.5 and PM10, ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide. Geneva, WHO, 2021.
Thompson LM, Bruce N, Eskenazi B, Diaz A, Pope D, Smith KR. Impact of reduced maternal exposures to wood smoke from an introduced chimney stove on newborn birth weight. Environmental Health Perspectives. 2011,119(10):1489–1494.
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