By PPH Foundation
Not all mothers face the same risk during childbirth. While Postpartum haemorrhage can affect any woman, some are significantly more vulnerable due to underlying biological and health factors that are often invisible until complications occur.
Postpartum haemorrhage, defined as excessive bleeding after childbirth, remains one of the leading causes of maternal deaths globally. Yet its occurrence is not random. Individual differences, ranging from genetics to pre-existing health conditions, play a critical role in determining who is most at risk.
One of the most common and preventable risk factors is anaemia. Women who enter pregnancy with low haemoglobin levels have reduced capacity to tolerate blood loss. Even what may be considered moderate bleeding can quickly become life-threatening. In many low-resource settings, anaemia is widespread, driven by nutritional deficiencies, infections, and limited access to early antenatal care.
Beyond anaemia, certain biological conditions increase the likelihood of excessive bleeding. Uterine atony, where the uterus fails to contract effectively after delivery, remains the leading direct cause of PPH. However, genetic predispositions affecting how the body regulates clotting can also contribute. Disorders related to blood clotting, though less commonly diagnosed, can significantly impair the body’s ability to stop bleeding once it begins.
Other underlying conditions, including prolonged labour, multiple pregnancies, retained placenta, and infections, further increase risk. These factors often interact, compounding vulnerability rather than acting in isolation.
Prof Moses Obimbo, a gynaecologist and the Project Lead of the End PPH Initiative, explains that understanding individual risk is essential for prevention.
“No two mothers are the same. Risk assessment must go beyond routine checks to identify underlying conditions such as anaemia, previous complications, or clotting disorders. Early identification allows for targeted care and preparedness, which can significantly reduce the risk of severe bleeding,” he says.
This is why antenatal care is not just a routine process, but a critical window for risk detection. Screening for anaemia, reviewing medical history, and identifying high-risk pregnancies allow health providers to plan for safer deliveries. For high-risk women, this may include delivering in well-equipped facilities, ensuring availability of blood products, and preparing for rapid response interventions.
At the same time, awareness at the community level remains vital. Many women are unaware that conditions such as anaemia or previous complications increase their risk. Strengthening education and early screening can empower them to seek timely care and appropriate support.
Reducing maternal deaths requires moving away from a one-size-fits-all approach. Because when it comes to childbirth, understanding individual risk is not just good practice, it is the difference between life and death.
Sources
World Health Organization. WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva, World Health Organization, 2012.
World Health Organization. Trends in Maternal Mortality 2000 to 2023, Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA Population Division. Geneva, World Health Organization, 2023.
Kassebaum, N.J., et al. A Systematic Analysis of Global Anemia Burden from 1990 to 2010, Blood, 2014, Volume 123, Issue 5.
Nyfløt, L.T., et al. Risk Factors for Severe Postpartum Hemorrhage, A Case-Control Study, BMC Pregnancy and Childbirth, 2017, Volume 17.
Collins, P.W., et al. Haemostatic Management of Postpartum Haemorrhage, British Journal of Haematology, 2014, Volume 166, Issue 6.
Image by DC Studio on Magnific</a>