By PPH Foundation
Armed conflict affects maternal health in ways that are often invisible but deeply dangerous. Beyond the immediate risks of injury and displacement, war exposes pregnant women to prolonged psychological stress, fear, and trauma. Emerging research shows that these conditions can significantly increase the risk of complications during childbirth, including postpartum haemorrhage (PPH), one of the leading causes of maternal deaths globally.
During conflict, women frequently experience chronic anxiety, uncertainty about safety, loss of homes, and separation from family members. These experiences trigger the body’s stress response system, leading to the continuous release of stress hormones such as cortisol and adrenaline. According to research published in PubMed and the National Institutes of Health, prolonged elevation of these hormones can disrupt normal pregnancy and labour processes.
High cortisol levels are associated with increased blood pressure, premature labour, and impaired uterine function. Adrenaline, which prepares the body for “fight or flight,” can interfere with the hormones responsible for labour progression and uterine contraction. After childbirth, the uterus must contract firmly to compress blood vessels where the placenta was attached. If these contractions are weak or delayed, severe bleeding can occur, resulting in postpartum haemorrhage.
Research in the journal BMC Pregnancy and Childbirth has shown that chronic stress during pregnancy can alter hormonal balance and reduce the efficiency of uterine contractions after delivery, increasing the risk of excessive bleeding. Similarly, studies reviewed in The Lancet Global Health highlight that women living in conflict zones experience higher levels of psychological distress, which can translate into poorer maternal outcomes.
Conflict also compounds stress through displacement. Many pregnant women in war zones are forced to flee their homes, often travelling long distances under unsafe conditions. Life in refugee or internally displaced persons camps is typically characterised by overcrowding, food insecurity, poor sanitation, and limited access to healthcare. These conditions further elevate stress levels and weaken maternal health.
A review published by the World Health Organization on maternal health in humanitarian settings notes that psychological trauma during pregnancy is strongly linked to complications during labour and postpartum recovery. Women exposed to prolonged stress are more likely to experience prolonged labour, hypertensive disorders, and postpartum bleeding.
The danger becomes even greater when stress is combined with disrupted healthcare services. In many conflict areas, hospitals are damaged or understaffed, and access to skilled birth attendants becomes limited. This means that when postpartum haemorrhage occurs, lifesaving interventions such as uterotonics, surgery, or blood transfusion may not be immediately available.
The link between stress and maternal outcomes underscores an important but often overlooked reality: war harms mothers long before they reach a delivery room. The psychological burden carried during months of conflict can translate into physiological complications during childbirth.
Professor Moses Obimbo, Project Lead of the End Postpartum Haemorrhage Initiative, notes that maternal health cannot be separated from broader social and humanitarian conditions.
“Postpartum haemorrhage is often viewed as a purely clinical emergency, yet many of the risks begin long before labour. In conflict settings, prolonged stress, displacement, and weakened health systems combine to create conditions where preventable maternal deaths become more likely,” he says.
Understanding the biological and social pathways linking stress and postpartum haemorrhage is critical for designing effective maternal health interventions in conflict zones. Protecting pregnant women during war requires not only medical care, but also humanitarian responses that reduce stress, restore health services, and ensure safe delivery environments.
Sources
National Institutes of Health / PubMed research on stress hormones and pregnancy outcomes
BMC Pregnancy and Childbirth studies on stress and labour complications
The Lancet Global Health analyses on maternal health in conflict settings
World Health Organization reports on maternal health in humanitarian emergencies
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