By The PPH Foundation

Anaemia in pregnancy remains one of the most preventable contributors to severe maternal outcomes, including postpartum haemorrhage. While PPH is often discussed as an emergency that occurs during or after childbirth, its severity is strongly influenced by a woman’s health long before labour begins. Preventing anaemia during pregnancy is therefore a critical, yet frequently underutilized, strategy in reducing the impact of postpartum haemorrhage.

Anaemia reduces a woman’s physiological ability to tolerate blood loss during childbirth. When haemoglobin levels are low, even modest bleeding can quickly become life-threatening. Anaemia also affects uterine muscle strength, increasing the risk of uterine atony, the leading cause of postpartum haemorrhage. In settings where access to timely blood transfusion is limited, women who enter labour anaemic face significantly higher risks of complications and death.

According to Dr Beverly Mitei, an obstetrician gynaecologist at the Coast General Hospital, preventing anaemia should be treated as a core component of birth preparedness. She notes that many PPH-related deaths occur not solely because bleeding was excessive, but because women had insufficient blood reserves to survive it. “When a woman reaches labour already anaemic, the margin for survival is dangerously narrow. Preventing anaemia gives clinicians time and options when bleeding occurs,” she says.

Preventing anaemia in pregnancy requires a comprehensive antenatal approach that goes beyond supplementation alone. Early and repeated haemoglobin testing allows health workers to detect anaemia in its early stages and respond promptly. Iron and folic acid supplementation remains essential, but must be supported by dietary counselling that promotes iron-rich foods, including legumes, green leafy vegetables, animal-source proteins, and fortified staples. Addressing poor absorption and compliance is equally important.

Infections and underlying conditions also play a significant role. Malaria, intestinal worms, and chronic infections contribute to iron loss and impaired absorption, worsening anaemia during pregnancy. Integrated antenatal care that includes malaria prevention, deworming, and treatment of infections strengthens maternal resilience and reduces the likelihood that anaemia will compound bleeding risks at delivery.

The End Postpartum Haemorrhage Initiative, implemented by the PPH Foundation in collaboration with the University of Nairobi, the Kenya Obstetrical and Gynaecological Society, and the Midwives Association of Kenya, continues to advocate for prevention-focused maternal care. By positioning anaemia prevention as a frontline PPH reduction strategy, the Initiative emphasises that safer births begin long before labour.

Reducing postpartum haemorrhage is not only about emergency response. It is also about ensuring that women enter childbirth strong enough to survive it. Preventing anaemia in pregnancy remains one of the most practical, cost-effective, and life-saving investments in maternal health.

Sources
World Health Organization, Guideline on the prevention and management of anaemia in pregnancy
World Health Organization, WHO recommendations on antenatal care
UNFPA, Maternal nutrition and anaemia prevention
The Lancet Global Health, Anaemia and maternal outcomes

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