A Look at the Roadmap to Combat Postpartum Hemorrhage

The World Health Organization (WHO) launched The Roadmap to Combat Postpartum Hemorrhage (PPH) between 2023 and 2030 at the International Maternal Newborn Health Conference in May of 2023. The document recognizes that PPH is a severe threat to global maternal health, particularly impacting women in low and middle income countries (LMICs), and asserts a series of specific global calls to action in order to reduce maternal mortality caused by PPH in hopes of regaining traction with the 2030 Sustainable Development Goals (SDGs). 

This document holds particular importance because, despite the fact that PPH makes up approximately 20% of the global maternal death count annually, PPH innovation and new management strategies have remained stagnant over the last 30 years. Without the changes outlined in the roadmap, an estimated half a million women will die from PPH related causes by 2030 even though most instances of maternal mortality from PPH are known to be treatable and preventable. Thus, the research initiatives encouraged by the WHO are being treated with the utmost sense of urgency.

The Roadmap was developed using a comprehensive process which involved extensive research and stakeholder consultations. It prioritizes four key initiative areas: research, norms and standards, implementation and advocacy. These will collectively enable researchers to enhance PPH knowledge, reduce inefficiencies, discover new methods for implementation of prevention and treatment strategies and overall allow the global healthcare workforce to combat PPH. Much of the investments will be directed towards key PPH priorities that have been identified especially in high-burden maternal health countries.

One major goal outlined by the Roadmap is the need to establish an overarching set of guidelines for PPH management that can be used worldwide. It is the hope that these guidelines are continuously updated to include the most recent recommendations as PPH research continues to advance over the next several years. The guidelines developed will be part of a large unified initiative to design and implement solutions to address the current shortcomings of maternal health care in hopes of creating safer deliveries and postnatal care and quality assured medications and devices, among other goals. 

This roadmap emphasizes the importance of collaboration of all key figures in the PPH space to achieve future milestones with regards to lowering maternal morbidity and mortality due to PPH. Some of the barriers to implementation of positive change that persist in several regions today which were identified in the document included a lack of clear national policies and leadership, weak supply chain systems, poor staffing, training, or supervision of health care professionals, inequities in accessing quality healthcare, and the fact that women have limited rights or are of lower social status in many cultural contexts. The roadmap indicates a commitment to position research and initiatives in a way that ensures these barriers, among others, can be overcome in order to advance advocacy to prioritize PPH prevention within the international maternal health community. 

To support a cohesive effort, the PPH Roadmap will be distributed as extensively as possible to all leaders in the field of maternal health care. It will be published in easy to access online platforms, discussed at conferences over the next several years and translated into 6 UN Languages. In order to sustain progress in these efforts, it is most important  that there is a core set of indicators and a comprehensive monitoring framework to track progress and evaluate impact. The present challenge facing leaders is finding universal indicators for PPH, but research studies such as the E-MOTIVE Trial offer frameworks that could serve as examples. Collaborative efforts of WHO, FIGO, ICM, and Ministries of Health, as well as national professional societies are necessary to select indicators for a common measurement platform and ensure sustainability through country leadership. Establishing this monitoring framework is one of the essential milestones within the PPH Roadmap.

Though the roadmap highlights lofty goals, and requires collaboration from maternal health experts across the globe, its established guidelines and research plans offer promising future solutions to reduce preventable maternal deaths from PPH.