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For a long time, Angela Nguku, a midwife, advocate and founder of White Ribbon Alliance Kenya, did not speak about her personal experience of postpartum haemorrhage, or severe bleeding after childbirth. This condition is the leading cause of maternal mortality, accounting for more than 20% of all maternal deaths recorded globally.
It was only last year, at the summit hosted by the World Health Organization (WHO), that Nguku began to share her story. Following the Postpartum Haemorrhage Summit, WHO and its partners launched a Roadmap for combatting postpartum haemorrhage by 2030, with a milestone tracker for accountability toward progress on this key issue.
For Women’s Health Month, Nguku spoke with the United Nations’ Human Reproduction Programme (HRP) about her work and what needs to be done to reduce deaths from this devastating condition.
HRP: How did you become an advocate for preventing and treating postpartum haemorrhage?
Nguku: I became a midwife over 17 years ago. After I graduated, I went to work in South Sudan, and that changed my life. I witnessed mothers dying in childbirth, with the majority dying from post-partum haemorrhages. I watched helplessly as some bled to death, since I did not have what I needed as a midwife to save them. That struck me and I started raising the visibility and profile of mothers and newborns dying in childbirth from preventable causes, which led to the founding of White Ribbon Alliance – Kenya. I have been doing that ever since.
HRP: What made you decide to start sharing your own experience?
Nguku: That is a hard one because as I tell my story, I know I am telling it from a place of privilege. As a young midwife, and a mother-to-be then, I did not imagine that I could suffer from any childbirth complications. But we know that any pregnancy can have complications and I experienced heavy bleeding with the birth of my son 16 years ago. I survived it thanks to the fast, quality care that I received in a private hospital in Nairobi. Sadly, unlike me, many women who suffer from postpartum haemorrhage live in low-resource settings and cannot access that kind of care, and that upsets me so much.
HRP: What is the White Ribbon Alliance – Kenya doing to help advance the Roadmap and address postpartum haemorrhage in Kenya?
Nguku: At White Ribbon Alliance – Kenya our ASK-LISTEN-ACT approach guides how we do our advocacy work. We start by asking women and girls what their real needs are and what they want to see changed. We are using storytelling as a new tactic to show the burden of postpartum haemorrhage in Kenya.
Women have told us many things. For example, they say that they are encouraged to go to the facility for delivery. However, in some of the health facilities, there is nothing to support them once the haemorrhaging starts. In most of the areas that we work in, there are few midwives to follow up with mothers who have recently given birth and who could be victims after discharge.
I think about a woman who, after six hours of labour in a low-level health facility, noticed that she was bleeding heavily. When she alerted the nurses, they said what she was experiencing was normal, so she went home. Soon after, she fainted and was rushed back to the clinic where the health workers didn’t know what to do. She said there was no ultrasound machine to check the cause of the bleeding or any medication to stop the bleeding. She had to transfer to a county hospital, where her bleeding finally stopped.
HRP: What’s the next phase of this work? What’s the call to action?
Nguku: The next phase is taking these stories from the grassroots to the national and global forums and into newsrooms to inform and shape the narratives. We hope that these real stories will change the hearts and souls of those who make decisions and secure investments for postpartum haemorrhage specifically.
One of the things that really bothers me is that policymakers mostly look at health care as simply building a facility. Strong health systems are composed of so much more than buildings; – we need these facilities to be staffed with well-trained health workers and filled with supplies and equipment to deliver high-quality, life-saving care.
There are issues of transport, referral, supplies, blood banks, and getting information to the communities. Engaging people who have experienced the condition will help us find and fill the gaps.
There are so many people that need to be involved: communities, midwives and everyone who is there at the facility, in addition to policymakers who make the resourcing decisions, the private sector and manufacturers of products for treatments. I wish to see relevant investments localized and fully understood by all actors.
That is my call to action: Make postpartum haemorrhage everyone’s business. Otherwise, the Roadmap will be just be another document on our shelves.
Main Image on top by Enoch111 from Pixabay
