KAMPALA, Uganda – In the relentless, high-pressure maternity ward of Kawempe National Referral Hospital, Uganda’s busiest public birthing centre, a quiet revolution is underway. Amid the beeping of machinery and cries of newborns, there is the well-orchestrated choreography of doctors, nurses and midwives saving mothers’ lives during postpartum haemorrhage.
Postpartum haemorrhage, or severe bleeding after childbirth, is the leading cause of maternal death globally – yet it is often completely preventable, and when it occurs, it is treatable. UNFPA is working with health systems and partners to ensure health workers have the right supplies and skills to prevent this complication from turning fatal.
Midwife Brenda Nakanwagi has seen firsthand how the right tools and training work. She has used them herself at the Kawempe Hospital, which records over 20,000 deliveries annually.
Just recently, she was guiding 28-year-old Jalia Namusisi through labour. But shortly after delivering a healthy daughter, Ms. Namusisi began to bleed.
Midwife Nakanwagi saw it right away – the blood loss was captured on a calibrated drape, used by hospital staff to measure bleeding and diagnose postpartum hemorrhage.
"There is no time to think at that moment; every second is blood lost," said Nakanwagi.
The ward team was activated, swiftly initiating well-practiced actions – massaging the uterus, administering oxytocic drugs to stimulate uterine contractions, using tranexamic acid to reduce bleeding and providing intravenous fluids.
Within minutes, the bleeding was controlled, and Ms. Namusisi’s vitals were stabilized.
"I felt the panic of the staff, but Brenda’s voice was calm," the new mother recalled, holding her baby girl. "She kept telling me what they were doing. They saved my life by being ready for the worst."
Ready for action
Kawempe Hospital is at the centre of a national effort to equip midwives, nurses and doctors with the skills to confront the most urgent birth-related emergencies.
"The training we conduct with support from UNFPA transforms dedicated individuals into a cohesive, life-saving unit," said Annette Kanyunyuzi, president of the National Midwives Association of Uganda (NMAU). "Midwives are the heart of maternal health, and by drilling them on protocols, we are replacing hesitation with automatic, synchronized action. This is the most powerful weapon against PPH [postpartum haemorrhage] mortality."
And training efforts are only set to get better.
On 5 October, the first-ever observed globally observed Postpartum Haemorrhage Day, UNFPA, the World Health Organization and other partners released “Bleeding after birth”, a training course for skilled birth attendants like doctors and midwives. The course was launched to support the implementation of new global guidelines for diagnosing and treating postpartum haemorrhage.
These materials will benefit the hundreds of thousands of health workers that UNFPA trains each year. Just last year, for example, UNFPA-supported training reached over 226,000 midwives.
All hands on deck to end postpartum bleeding
But training is not enough. New supplies are also needed.
Tranexamic acid and heat-stable carbetocin, for example, are medications that can prevent and treat haemorrhage but are not yet widely used in Africa. The drugs’ cost is a barrier to many health systems, even as they offer significant advantages. Carbetocin, for instance, does not require a cold chain – the system of consistent refrigeration through production and delivery – making it especially useful in remote and rural areas with limited infrastructure and inconsistent electricity.
Other measures are also essential to ensuring that affordable and quality-assured supplies reach health workers, including sustainable financing, updated national essential medicines lists and protocols, regulatory harmonization and regular national procurement, alongside well coordinated introduction plans for new products.
Fortunately, partnerships between and among health workers, national health authorities, and international organizations like UNFPA are already moving the needle.
The health worker training at Kawempe Hospital, for instance, is part of joint efforts between the UNFPA, the Ministry of Health, NMAU and the European Union.
That collaboration is itself also part of the SafeBirth Africa initiative, an EU-funded and UNFPA-supported project implemented by Unitaid and national health authorities across the region. SafeBirth Africa is designed to accelerate access to new life-saving interventions and maternal health commodities.
And these efforts are complemented by support for UNFPA’s dedicated fund for maternal and newborn health from Belgium, Denmark, Germany, Luxembourg, Poland, Sweden, Takeda Pharmaceuticals, and World Diabetes Foundation.
