By PPH Foundation
A woman in labour may know exactly where she needs to go, but reaching the hospital can become an emergency of its own when roads are flooded, damaged or too difficult for an ambulance to navigate. For a woman who develops postpartum haemorrhage, PPH, after childbirth, the journey can become even more critical because the blood, medicines, skilled health workers and emergency interventions needed to stop severe bleeding may be available only at a referral facility. Climate change does not directly cause PPH, but by disrupting roads, transport and access to health facilities, extreme weather can make it harder for women experiencing obstetric emergencies to receive timely care.
This is becoming an increasingly important maternal health concern in Kenya. According to Matanda et al. (2026), whose qualitative study examined women's and health stakeholders' experiences in Kisumu and Migori counties, changing weather patterns, including prolonged rainfall and flooding, are disrupting access to antenatal care. Women participating in the study described flooded roads, damaged infrastructure and difficulties moving to health facilities, while some reported that motorbike riders were reluctant to transport pregnant women because of the risks associated with poor road conditions.
For a woman in labour, therefore, the challenge may not simply be how far away the hospital is, but whether she can get there safely and quickly.
Kenyan research has previously documented how infrastructure and transport barriers can complicate access to maternal healthcare. A 2015 study by Essendi et al., conducted in rural Makueni County, found that communities and health workers identified poor roads, lack of electricity and inadequate water infrastructure among the barriers affecting access to essential maternal and newborn services. The researchers noted that these infrastructure limitations could affect the ability of rural facilities to provide routine and emergency care.
These challenges become particularly serious when the complication is PPH.
Postpartum haemorrhage can require rapid intervention, including medicines to control bleeding, procedures to identify and stop the source of bleeding, blood transfusion and, where necessary, surgery. When these services are not available at the first facility, referral becomes part of the emergency response.
Evidence from Kenya also shows that the referral process itself can present significant barriers. According to Miller et al. (2024), a qualitative assessment of PPH management and referral in Kenya found that healthcare providers faced structural barriers, communication challenges between facilities, delays in decision-making and shortages of essential medicines and supplies. The researchers emphasised that effective communication and coordination between facilities are important for ensuring timely referral and care for women experiencing PPH.
When such challenges occur alongside extreme weather, the pathway to emergency care can become even more difficult.
Prof Julius Ogeng’o, Co-Lead of the End PPH Initiative, has emphasised the importance of ensuring that blood is available where mothers need it. His advocacy through the ROAMING Blood Initiative reflects the need to strengthen blood mobilisation and distribution, particularly for women living in rural and underserved communities.
Speaking about the ROAMING Blood Initiative, Prof Ogeng’o explained that its philosophy is to take blood donation and mobilisation closer to communities by building trust and creating networks of donors. The initiative seeks to connect donors, health facilities, ambulances and health personnel so that blood can be mobilised more efficiently when it is needed.
This approach becomes particularly relevant in communities where weather and terrain can make conventional transport difficult.
If a road is flooded, an ambulance may be delayed. If a bridge is impassable, a referral may have to take a longer route. If a woman is transported on a motorbike because no ambulance is immediately available, the journey may involve additional delays before she reaches definitive care.
The challenge, therefore, is not that travelling on a rough road causes PPH. Rather, the concern is what happens when a woman develops PPH and the systems required to respond to the emergency are separated by difficult terrain, inadequate transport and weather-related disruption.
The 2025 consolidated guidelines from the World Health Organization, the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives emphasise the importance of preventing, diagnosing and treating PPH effectively and ensuring that evidence-based interventions are available when women need them. The guidelines bring together recommendations covering care during pregnancy, childbirth and the immediate postpartum period, including health-system interventions.
This makes climate resilience an important part of maternal health planning. Health facilities need more than trained personnel and medicines. They also need functioning referral networks, reliable emergency transport, effective communication systems, blood availability and infrastructure capable of withstanding extreme weather.
The problem can become even greater in rural and hard-to-reach communities, where transport challenges already exist before a flood, heavy rainfall or other climate-related disruption occurs.
For families, the experience can be frightening. A woman who begins bleeding after childbirth may need urgent care, while those around her are simultaneously trying to find transport, raise money, contact a health facility or locate blood.
This is why climate change needs to be considered not only as an environmental issue, but also as a health systems issue.
A road that becomes impassable during heavy rainfall can affect whether a woman reaches maternity care. A delayed ambulance can affect how quickly she receives emergency treatment. A disrupted supply route can affect whether a facility has the medicines, equipment and blood needed to manage complications.
Strengthening maternal health therefore requires attention to the entire journey, from the community to the health facility and, where necessary, from the first facility to the referral hospital.
For a woman experiencing PPH, the road to the hospital is not simply a journey. It can become part of the emergency itself.
As extreme weather increasingly disrupts transport and health infrastructure, building climate-resilient maternal health systems may become just as important as strengthening the care provided inside the maternity ward.
References
Essendi, H., Johnson, F. A., Madise, N., Matthews, Z., Falkingham, J., Bahaj, A. S., et al. (2015). Infrastructural challenges to better health in maternity facilities in rural Kenya: Community and healthworker perceptions. Reproductive Health, 12, 103. https://doi.org/10.1186/s12978-015-0078-8
Matanda, D. J., Warren, C. E., Okoth, O., Otieno, B., & Nakuya, Z. (2026). ‘Water is a good thing, but when it destroys it is not good’: The influence of changing weather patterns on access to antenatal care services in Western Kenya — A qualitative study. PLOS Climate, 5(3), e0000882. https://doi.org/10.1371/journal.pclm.0000882
Miller, N., Henry, J., Opondo, K., Garg, L. F., Calvert, M., Clarke-Deedler, E., et al. (2024). “How I wish we could manage such things”: A qualitative assessment of barriers to postpartum hemorrhage management and referral in Kenya. PLOS Global Public Health, 4(11), e0003842. https://doi.org/10.1371/journal.pgph.0003842
World Health Organization, International Federation of Gynecology and Obstetrics, & International Confederation of Midwives. (2025). Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage. Geneva: World Health Organization.
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