FOR years, efforts to reduce maternal deaths have focused heavily on postpartum haemorrhage — the severe bleeding that can occur after childbirth. New evidence suggests that this focus, while important, may have overlooked a more fundamental threat. A major international study involving more than 15,000 women, including over 11,000 from Pakistan, concludes that anaemia may be responsible for most maternal deaths worldwide and could underlie a large proportion of severe postpartum haemorrhage cases. The findings should resonate deeply in Pakistan, where anaemia among women is alarmingly widespread. According to local estimates cited by the study’s Pakistani investigators, up to 70pc of pregnant women may be anaemic. This is a reflection of poverty, poor nutrition, unsafe water, inadequate sanitation, repeated pregnancies and limited access to preventive healthcare. Women often endure heavy menstrual bleeding, fatigue and dizziness for years without seeking treatment, either because services are unavailable or because such symptoms are normalised. The study found that women with moderate and severe anaemia can develop shock and organ failure after what would otherwise be considered moderate blood loss during childbirth. Women with severe anaemia were far more likely to suffer serious complications and maternal death. The risks extend to babies as well. Anaemia was linked with higher rates of premature birth, neonatal mortality and stillbirth. Among women with severe anaemia, the stillbirth rate reached 17pc.

To meaningfully reduce preventable maternal deaths, the response must begin long before labour wards and delivery rooms. The report calls for a life-course approach that includes screening girls and women for anaemia before and during pregnancy, ensuring access to iron and folic acid supplementation, improving nutrition and addressing underlying causes such as parasitic infections and unsafe drinking water. Public awareness is equally important. Many women dismiss persistent tiredness, breathlessness and heavy periods instead of seeking medical attention. Maternal mortality is often discussed in terms of emergency obstetric care. That is essential. But this research shows that many mothers arrive at childbirth already at a dangerous disadvantage. If the state is serious about protecting women and improving newborn survival, anaemia can no longer be treated as a secondary concern. It must become a central public health priority, backed by sustained funding, screening and prevention efforts.

Published in Dawn, June 21st, 2026