By PPH Foundation

When it rains, most people think of floods or transport disruptions. But inside maternity wards, damp, overcrowded, and poorly ventilated conditions can quietly increase the risk of postpartum haemorrhage, PPH, and make it harder to save mothers when bleeding occurs.

Postpartum haemorrhage remains the leading cause of maternal death globally, responsible for nearly one in five maternal deaths, according to World Health Organization estimates. This burden is not only driven by clinical factors, but also by the quality-of-care environments where women deliver.

During rainy seasons, many health facilities, particularly in low-resource settings, experience leaking roofs, high humidity, and overcrowding. Evidence from the World Health Organization highlights that poor facility conditions and inadequate infection prevention significantly increase the risk of maternal infections around childbirth. These infections, including sepsis, are closely linked to maternal deaths and complications.

The connection to PPH is direct and critical. Research shows that infections can interfere with uterine contraction and the body’s clotting mechanisms, both essential in stopping bleeding after delivery. According to WHO guidance on maternal health, sepsis and poor postpartum recovery can worsen bleeding outcomes and increase the likelihood of severe haemorrhage.

Beyond infection, damp and cold environments also affect maternal recovery. Studies on quality of care indicate that poorly ventilated and overcrowded wards reduce effective monitoring during the immediate postpartum period, when most PPH-related deaths occur. When facilities are strained, early warning signs such as excessive bleeding may be missed, delaying life-saving interventions.

Global recommendations, including the WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage, emphasize that preventing PPH is not only about uterotonics and emergency response, but also about ensuring safe, clean, and well-functioning care environments. Similarly, broader maternal health evidence from the State of the World’s Midwifery Report underscores that health system conditions, including infrastructure and staffing, are critical determinants of maternal outcomes.

Prof Julius Ogeng’o, Co-Lead of the End PPH Initiative, highlights this often-overlooked link.
“Postpartum haemorrhage is not just a clinical event, it is highly dependent on the environment in which care is delivered. When facilities are overcrowded, damp, and under-resourced, the ability to prevent, detect, and manage bleeding is significantly compromised. Strengthening infrastructure is as critical as strengthening clinical capacity.”

The implication is clear. Even when health workers are skilled and medicines are available, poor facility conditions can undermine care. Addressing PPH therefore requires strengthening maternity infrastructure to withstand seasonal weather changes, improving ventilation and infection control, reducing overcrowding, and ensuring adequate staffing and supplies.

As the rains continue, the message is urgent. Preventing deaths from postpartum haemorrhage requires not only the right interventions, but the right environment. Because when care spaces fail, mothers pay the price.

Sources

World Health Organization. WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva, WHO, 2012.

World Health Organization. Maternal Sepsis and Infection Prevention in Childbirth, WHO Guidelines and Evidence Base. Geneva, WHO.

United Nations Population Fund. State of the World’s Midwifery Report 2021. New York, UNFPA, 2021.

World Health Organization. Trends in Maternal Mortality, 2000 to 2020. Geneva, WHO, 2023.

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