By PPH Foundation
A woman can be bleeding heavily after childbirth, but getting the decision to transfuse is only the beginning of another emergency.
Once postpartum haemorrhage becomes severe enough to require blood, survival may depend on a chain of events that happens largely outside the delivery room. Blood has to be available, correctly identified, screened, prepared, released, transported and delivered to the woman in time. When one link in that chain fails, a clinical team may recognise the emergency and be ready to act, yet still be unable to replace the blood the woman is losing.
The issue, therefore, is bigger than asking whether people have donated enough blood. It is about whether the health system can move safe blood from the point of donation to the patient quickly enough when every minute matters.
According to the World Health Organization’s 2025 Consolidated Guidelines for the Prevention, Diagnosis and Treatment of Postpartum Haemorrhage, blood transfusion may be required when bleeding continues despite initial treatment, and decisions about transfusion should be based on continuous clinical and haematological assessment, the woman’s underlying risk and clear protocols for the use of blood products. The guideline also emphasises that health workers need to understand the procurement and logistics channels for blood products and the potential limitations of availability.
This makes blood preparedness part of emergency obstetric care, not an activity that begins only after a woman starts bleeding.
The first challenge is recognising how quickly a situation can deteriorate. Blood loss after childbirth can progress rapidly, and visual estimation alone may underestimate the amount of blood being lost. Recent research involving facilities in Kenya, Zambia and Nigeria has highlighted the importance of objective measurement of blood loss for earlier recognition and treatment of PPH. The study, published in the International Journal of Gynaecology and Obstetrics in 2026, argues that moving from guesswork towards objective measurement can help clinicians identify women who need treatment earlier.
Early recognition matters because it gives the rest of the system time to respond.
Once the need for transfusion is identified, however, another sequence begins. The woman’s blood group and clinical situation have to be considered, appropriate blood or blood products have to be located, and the products must undergo the required safety and compatibility procedures. Blood is not simply taken from a refrigerator and connected to a patient. It moves through a regulated transfusion system designed to ensure that the product given is appropriate and safe.
This is where the strength of the wider blood system becomes critical.
A major systematic review published in June 2026 in Frontiers in Health Services examined 65 studies covering 18 countries in sub-Saharan Africa. According to Oreh and colleagues, the barriers to blood and blood product access included transfusion delays, blood stock-outs, untimely referrals, inadequate transfusion management systems, shortages of health workers and weak adherence to standardised protocols. The review also identified stronger referral systems, health information systems, skilled personnel and innovations in transport and technology as potential facilitators.
The findings are important because they show that blood availability is not a single point in the system. A facility can have access to a blood service and still experience delays in getting the right product to a woman who needs it.
Distance can matter. Transport can matter. Communication between facilities can matter. Blood storage and cold-chain capacity can matter. The time taken to process, release and move blood can matter.
In a severe haemorrhage, these are not administrative details. They can become clinical factors.
Kenya has seen how delays can accumulate during maternal emergencies. In a recent Associated Press report from Kilifi, the family of 29-year-old Penina Zawadi said she experienced severe bleeding after a caesarean section and spent hours at Malindi Hospital awaiting transfer to Kilifi County Referral Hospital, about an hour away by road. She later died after spending several days in intensive care. The report highlighted wider challenges involving shortages of resources, transport and emergency capacity.
The case does not represent a single explanation for maternal death. Instead, it illustrates why emergency care has to be viewed as a chain. Recognising a complication is important, but recognition must be followed by treatment, referral when necessary, blood access and definitive care.
The same principle applies to blood itself.
A blood unit has to remain safe throughout its journey. That means appropriate storage and temperature control are part of the life-saving chain. The PPH Foundation has recognised this dimension through its engagement with Drop Access, exploring the use of IoT-enabled portable solar refrigeration to strengthen cold-chain capacity for the ROAMING Blood Initiative and the storage of temperature-sensitive medicines used in PPH management.
Prof Julius Ogeng’o, Co-Lead of the End Postpartum Haemorrhage Initiative, has emphasised that blood access should be understood as a shared responsibility rather than simply a hospital supply issue.
“Blood access is not simply a clinical supply issue; it must be a family and community priority. When families plan ahead, know blood types, and engage with blood donation systems before delivery, we see faster responses and lives saved.”
That wider approach is reflected in the PPH Foundation’s ROAMING Blood Typing and Acquisition Scheme.
Rather than treating blood donation as an isolated campaign, ROAMING seeks to strengthen the connection between communities, blood donors and the health system. The initiative was piloted in 2025 across 12 sites, collecting more than 800 units of blood and conducting on-site blood-group testing for nearly 760 people. It also developed a digital blood-group registry and prototype web-based management system intended to strengthen donor coordination and improve access during emergencies.
The Foundation has subsequently moved towards expanding the model, working with partners including the Kenya Red Cross Society, Kenya Tissue and Transplant Authority, Ministry of Health, Eldon Biologicals and health facilities. The 2026 expansion is targeting more than 10 counties, with plans to mobilise more than 5,000 donors and more than 2,000 units of blood.
The significance of ROAMING is therefore not simply the number of units collected. Its larger value lies in the attempt to address the gap between knowing that blood is needed and having a system capable of getting that blood to the woman who needs it.
This is why the question during a maternal emergency should not stop at, “Do we have blood?”
The more important questions are: Where is it? Has it been appropriately screened and prepared? Is the required blood product available? Can it be released quickly? How far is it from the facility? Is there a reliable transport mechanism? Can the blood remain safe during transport? And, if the woman requires referral, can the blood and the patient move through the system without dangerous delays?
The answers to these questions determine whether blood donation becomes actual lifesaving care.
The WHO’s 2026 implementation guide for the new PPH guidelines reinforces this systems approach. It calls for countries to identify implementation barriers, strengthen health worker capacity, and improve the quantification, procurement and distribution of commodities needed to prevent and manage PPH.
For women experiencing severe postpartum haemorrhage, preparedness cannot begin after the bleeding starts. The blood system, referral system, transport system, storage system and clinical team all have to be ready before the emergency occurs.
Blood donation remains essential. But donation is only the beginning.
The real measure of preparedness is whether a woman who needs blood can receive the right blood, safely and quickly, before the effects of severe blood loss become irreversible.
That is the second emergency we must learn to see.
References
- World Health Organization. 2025. Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage. Geneva: World Health Organization.
WHO, Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage, 2025 - World Health Organization. 2026. Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage: Implementation guide. Geneva: World Health Organization.
WHO, PPH Guidelines Implementation Guide, 2026 - Njogu, R., Tappis, H., Orji, B.C., Kapoma, S., Adepoju, V.A., Ndhlovu, M., Roman, E., Muthamia, M.M., Lathrop, E. & Evans, C. 2026. ‘From guesstimates to game changers: Introducing objective measurement of blood loss for timely postpartum haemorrhage detection in Nigeria, Zambia, and Kenya’. International Journal of Gynaecology & Obstetrics, 172, S17–S25. https://doi.org/10.1002/ijgo.71048.
PubMed, Njogu et al., 2026 - Oreh, A., Ajayi, K.V., Okoroiwu, H.U., Obeta, U.M., Maduoma, C., Owusu-Ofori, S., Postma, M., Nwagha, T. & van Hulst, M. 2026. ‘Facilitators and barriers to blood and blood product accessibility and use in sub-Saharan Africa: a systematic review’. Frontiers in Health Services, 6, 1837188. https://doi.org/10.3389/frhs.2026.1837188.
PubMed, Oreh et al., 2026 - Associated Press. 2026. ‘A Kenyan mother bled for hours after childbirth and died as healthcare remains weak’. Associated Press, 2026.
Associated Press, A Kenyan mother bled for hours after childbirth and died as healthcare remains weak - Image by brgfx on Magnific</a>