A study examining 31 countries reveals that updated global health guidelines for postpartum hemorrhage (PPH) and hypertensive disorders of pregnancy (HDP) have failed to produce uniform care standards, leaving thousands of women exposed to unnecessary risks. Although the World Health Organization has issued recommendations for years, persistent shortages of essential drugs, inadequate provider training, and insufficient oversight in private healthcare settings continue to hinder efforts to reduce maternal deaths worldwide.
Research shows oxytocin, the primary treatment for PPH, is now accessible in 77% of public facilities and 84% of private ones. However, magnesium sulfate, the standard treatment for HDP, remains critically understocked, with only 58% of public facilities and 45% of private facilities holding supplies. While misoprostol availability has improved since 2012, newer interventions such as tranexamic acid and heat-stable carbetocin are rarely deployed in clinical settings.
Most nations have incorporated WHO guidelines into national policies, but adoption rates for specific protocols remain uneven. Only 45% of countries include heat-stable carbetocin in their guidelines, and just 13% address umbilical vein oxytocin for retained placenta cases. The private sector, which delivers a substantial portion of maternity care in low- and middle-income countries, frequently operates without adequate oversight. Fewer than half of nations require private facilities to report key PPH and HDP data to national health systems.
Midwives’ ability to perform critical procedures, such as manual placenta removal or administering magnesium sulfate, has seen minimal improvement over the past decade. Many regions still lack standardized, competency-based training programs for both public and private healthcare providers. Without expanded training and consistent protocols, life-saving interventions may not reach women during emergencies.
The report outlines three essential steps to address these shortcomings: integrating updated guidelines across all care settings, expanding midwives’ emergency roles, and strengthening supply chains. Collaboration between public and private sectors is essential, as private facilities often serve populations that public systems cannot reach.
