Fifteen years in the past, Arri Coomarasamy was invited by a good friend to spend a few weeks in Malawi. The then-38-year-old was coaching to be an IVF physician and made plans to go to a neighborhood hospital.
“I remember going into the room, which was in fact the mortuary, and there were three dead women,” he says. Two had died of the identical trigger: they’d bled to demise after giving delivery. “I guess what I saw in that room has never really left me in my professional life“.
It started him on a journey to understand why so many women in poorer countries were dying from postpartum haemorrhage, or excessive bleeding after childbirth, which remains the leading cause of maternal deaths around the world.
Research, spearheaded by now Professor Coomarasamy and the University of Birmingham, discovered a way of stopping 60 per cent of cases of deadly bleeding – thanks to a mixture of better diagnosis, medication and training. However, key US-funded programmes that had just started to bring that knowledge to patients have been slashed in size, meaning it has been stopped from reaching thousands of women.
Despite repeated claims by US officials to protect lifesaving work, following Donald Trump’s slashing of foreign at the start of 2025, a plan was put in motion to cancel one such programme, called Momentum Country and Global Leadership, in more than 10 out of roughly 25 countries where it previously operated. Dedicated to getting healthcare to pregnant women and children, it has been curtailed in some of the poorest countries with the highest maternal mortality, The Independent has learnt.
One aspect of the approach involves teaching midwives and doctors best practice on how to reduce cases of haemorrhage. Several insiders connected to the work have told The Independent that cuts to a range of programmes mean this life-saving opportunity will now not make into a number of clinics. “There is no doubt in my mind that the cuts have massively impacted the rollout of [the approach] and other similar effective interventions, which are life-saving,” Coomarasamy, now an Oxford professor of reproductive medication, says.
A US State Department spokesperson stated: “The Trump Administration remains committed to saving lives and improving maternal health outcomes globally. Under the America First Global Health Strategy announced in September 2025, we are prioritising direct investments in frontline healthcare workers and essential health commodities—including those that prevent maternal mortality—while eliminating wasteful overhead and ensuring US assistance builds sustainable, locally-led health systems”.
‘A medical scandal’
Women in wealthy nations have an analogous probability of dealing with haemorrhage as these residing in poorer nations. “What differs is the likelihood of you dying,” Coomarasamy explains. “What you start to realise quite quickly is that a woman doesn’t need to die from postpartum haemorrhage”.
He had found what he considers to be a “medical scandal”: half of all instances of life-threatening bleeding had been going undiagnosed.
The first downside was that well being employees weren’t excellent at recognising by sight when a girl was shedding an excessive amount of blood and had been diagnosing harmful instances too late.
Secondly, even as soon as extreme bleeding was recognized, it was taking too lengthy to provide sufferers a therapy that labored. Hospitals had been making an attempt one therapy and ready to see if it labored earlier than shifting on to the following one – a standard method in medication, however a dangerous one when somebody is bleeding closely and time is of the essence.
“We realised that what kills the woman when she bleeds is really the ticking clock,” Coomarasamy says.
“The more that the time passes from the moment that the woman starts to bleed, the greater the blood loss,” and the better the probabilities she’s going to want extra intensive therapy or will lose her life.
While in richer nations, ladies have the protection nets of surgical procedure, blood transfusions and intensive care, in lower-income nations they don’t reliably have these choices.
The breakthrough got here in 2023. As a part of a trial, the group launched into clinics a plastic blood-collection machine often known as a drape, positioned underneath a affected person throughout delivery to extra precisely measure how a lot they’re bleeding, and establish quicker if they’re shedding harmful quantities. And they experimented with giving all of the various kinds of therapy we already know to be efficient on the identical time: oxytocin to contract the uterus; tranexamic acid to clot the blood; an IV drip to exchange fluids.
The outcomes had been transformative; collectively this straightforward method decreased extreme bleeding, surgical procedures and deaths by 60 per cent – a unprecedented discovering in trendy medication.
Coomarasamy realised partway by the trial that one thing totally different was occurring when he visited clinics within the trial nations. Health employees would collar him and frantically ask how they had been going to get the drapes and medicines as soon as the analysis completed.
“They would tell me…‘it definitely works, we’ve not had any women dying. You know we normally have two, three bags of emergency blood in our fridge – it hasn’t been touched’”.
Now the analysis simply wanted to succeed in sufferers. It’s this work that has stumbled in quite a few nations in current months for the reason that US cuts had been introduced.
‘We are putting lives of women and newborns at risk’
In Malawi, the place Coomarasamy had the revelation that began him on this path some decade-and-a-half in the past, the results appear to be already enjoying out.
Nurse Victoria Mzungu remembers one delivery significantly clearly. A girl had delivered twins prematurely on her method to the hospital, and was bleeding closely. She arrived pale and struggling for air because the proteins in her blood liable for getting oxygen to her cells plummeted. The group rushed to provide her all of the therapy they’d at their disposal, and the girl survived.
Mzungu places the girl’s survival all the way down to the brand new coaching. In the three clinics in in her district of Salima the place the method had been launched to this point, no maternal deaths from bleeding have been registered this 12 months.
But for the reason that US funding was resulted in sure areas, they haven’t had entry to key medicine and tools together with the drapes. “We haven’t stopped,” she says, however the group is left making an attempt to make use of the method with out these essential substances, “using the available resources… on the ground.”
The charge of pregnant ladies within the district attending a minimal of 4 antenatal visits has fallen from 41 per cent to 36 per cent since January. That in flip has hit the numbers of ladies getting vital dietary supplements like iron – which might scale back the chance of demise from bleeding in childbirth.
It’s largely all the way down to the cancellation of outreach programmes designed to get medical care to distant communities, the place individuals dwell 30km or extra from their nearest well being facility. This means, “a pregnant woman has to walk once every month for nine months for antenatal services,” says Hester Nyasulu, Malawi nation supervisor at charity Amref. “She has to brave that 30 kilometres. Now, if it’s in the eighth month,” he says, “that’s not an easy thing.”
As a consequence, ladies are lacking scheduled antenatal visits, “so already we are putting lives of women and newborns at risk,” he says, and risking reversing beneficial properties made in recent times.
In poorer nations, ladies usually tend to begin their pregnancies with dietary deficiencies which elevate their probabilities of getting very sick in the event that they do haemorrhage, making this sort of prevention all of the extra vital.
Two hours north of Salima, in Nkhotakota district, clinics misplaced monitor of 900 pregnant ladies and recorded greater than 2,000 fewer antenatal visits after the US cuts. Cases of extreme bleeding have jumped again as much as the place they had been when a US-funded programme began in 2022, having halved in that point. An audit report seen by The Independent discovered a girl who died from haemorrhage may have survived if the cuts hadn’t taken place, inflicting gaps in data and tools together with surgical clothes to cease bleeding.
Another strand of the US-funded work, run by WaterAid, was ensuring maternity wards had clear water and bathroom amenities, together with in Salima. This too has been stopped, leading to a fall in ladies attending the clinics, the charity says, as a result of they know they may face unhygienic and “dehumanising” amenities.
A State Department spokesperson stated the US was at present offering almost $12m to Malawi for maternal, new child and baby well being.
‘I feel like we’re going back 20 years’
After Trump’s cease work order initially froze all overseas assist spending in a single day, US programmes on maternal well being had been cancelled and resurrected a number of occasions, inflicting confusion. Now the mud has settled, former and present staff finishing up US-funded maternal well being programmes have instructed The Independent that the cuts imply, “there’s just not the same support” for ensuring amenities have all the things they should deal with lethal bleeding”, says postpartum haemorrhage professional Cherrie Evans, and that plans to scale the coaching up have “stalled” in quite a few locations.
“You can have the best intervention but if you can’t get it implemented with the medicines, supplies, and skilled workers you need, it doesn’t matter,” she says. “I feel like we’re going back 20 years in the programming we’re being asked to do”. This will significantly influence nations like Tanzania with much less strong well being techniques which weren’t as far superior in introducing a number of the new data round tackling bleeding.
Part of the explanation this work was solely simply getting began, insiders and specialists agree, is the broader neglect of maternal well being, which is usually not seen as an emergency by governments. Diseases like HIV or malaria have had complete programmes devoted to tackling them with medicine and prevention. Though main beneficial properties have been made on maternal well being in current a long time, progress has been slower.
“People have always said, and it’s absolutely true, that if you can manage to solve the problems of maternal health, you will have solved many of the key health system problems,” says Deborah Armbruster, previously a senior maternal and new child well being advisor for the United States Agency for International Development (USAID).
Efforts to get the brand new method to tackling haemorrhage into clinics had been, “very nascent,” a clinician who didn’t need to be named says, with work “just barely getting started”.
In its new type, it’s not solely reaching roughly half as many nations, however now comes with the situation from the US State Department that it could actually solely give attention to “lifesaving interventions,” together with medicines – however excluding any point out of gender or household planning – Suzanne Stalls, a number one nurse-midwife beforehand affiliated with the programme explains.
She says that this is identical kind of labor that has been happening for 25 years and, whereas vital, that medical workers have “learned it wasn’t enough” to reliably save moms lives.
“Diagnosis is fundamental in medicine,” Professor Coomarasamy says. “You can have the perfect treatment,” he provides, but when there aren’t issues in place to be sure that sufferers each make it into clinics and have entry to a check that picks up the situation, “you’re not going to be able to use this perfect treatment”.
This article has been produced as a part of The Independent’s Rethinking Global Aid undertaking
https://www.independent.co.uk/news/world/africa/uk-aid-cuts-deaths-mother-baby-b2884940.html