Tanzania, Rwanda hailed for fight against maternal deaths at UNGA

As discussions at the United Nations General Assembly draw to a close, a man in Kenya is left with memories of a wife who went to hospital to give birth but never returned home.

She had given birth. Then the bleeding began.

On September 9, 2025, Joseph Wanyonyi and his wife, Phyllis Wanjiru, went to a private hospital to book an appointment with a gynaecologist and the maternity ward.

Phyllis, who was expecting their fourth child, appeared well. She was active, climbing stairs and joking with her husband.

But after seeing the doctor, Joseph was told his wife needed to go to theatre immediately.

He questioned why, because she was not in pain.

At around 2 pm, Phyllis delivered a healthy baby girl through a Caesarean section.

Joseph was told that both mother and baby were doing well.

Later, however, Phyllis began complaining of pain and said she was feeling cold. Nurses told the family that such discomfort could be normal after a Caesarean section.

Then, at around 9 pm, Joseph received a call.

“Babe, I’m scared. They want to refer me to Kenyatta National Hospital. Please come.”

When Joseph arrived at Kenyatta National Hospital, he learnt that his wife had lost a massive amount of blood internally.

Phyllis was O negative, and there was not enough blood immediately available.

Doctors suspected that the bleeding could have been coming from the uterus and recommended surgery, including a hysterectomy.

Phyllis agreed.

“Do whatever it takes to make me okay,” she told them.

But the bleeding continued.

Around 9 am the following day, Joseph was called to the intensive care unit and asked to help find blood.

He turned to social media.

Friends, relatives and strangers responded, helping to mobilise blood.

But it was too late.

“I’m sorry. We lost her,” a doctor told him.

A postmortem later confirmed massive postpartum haemorrhage.

The newborn daughter will grow up without knowing her mother.

“Phyllis’ mother helped care for the baby and relied on formula milk.” Wanyonyi recounts

Her daughter, Abigael, still asks: “When is mummy coming back from the hospital?”

Phyllis’ death is one family’s tragedy, but the circumstances surrounding it mirror a much larger maternal health crisis now being discussed at the United Nations General Assembly.

The new Africa Centres for Disease Control and Prevention evidence review estimates that about 178,600 women died from pregnancy and childbirth-related causes in African Union member states in 2023.

That was about 69 per cent, or nearly seven in every 10, of the estimated 260,000 maternal deaths globally that year.

The same review estimates that African Union member states account for about 1.18 million newborn deaths every year, representing 51 per cent of the global total.

The findings, contained in The Causes and Drivers of Maternal and Child Mortality in Africa, released on September 9, 2026, form part of the evidence behind Africa’s renewed push for faster action on maternal, newborn and child survival.

At the centre of that continental push is the “Three Zeros” agenda: zero home deliveries, zero preventable maternal and newborn deaths, and zero unvaccinated children.

The objective is to turn political commitments into measurable action before the 2030 deadline.

Dr Dennis Miskellah, a reproductive health specialist, says postpartum haemorrhage can occur after both Caesarean and vaginal deliveries, particularly in cases involving uterine atony, trauma or retained placenta.

“Maternal deaths from PPH are caused not only by bleeding itself but also by delays in diagnosis, treatment, and access to blood or essential drugs,” he says.

He says the danger can be missed because blood loss is often underestimated.

“By the time you notice 500 millilitres of blood loss, the woman may already have soaked through her clothes and bedding,” he says.

The World Health Organisation has also moved towards earlier detection and intervention for postpartum haemorrhage.

Its latest guidance recommends action when blood loss reaches 300 millilitres and is accompanied by abnormal vital signs, or at 500 millilitres regardless of vital signs. It also recommends objective measurement of blood loss and the rapid use of a treatment bundle known as MOTIVE — uterine massage, oxytocic medicines, tranexamic acid, intravenous fluids, examination to identify the source of bleeding and escalation of care where necessary.

The approach is backed by evidence from the E-MOTIVE trial, conducted in hospitals in Kenya, Nigeria, South Africa and Tanzania, which found a 60 per cent reduction in severe bleeding when early detection and a treatment bundle were implemented.

For Dr Miskellah, however, sophisticated interventions will not help if basic emergency systems are missing.

“No mother should die because a facility lacked the basics,” he says.

He adds: “No theatre performing a caesarean section should operate without blood on standby.”

He advocates a “Code Red” emergency response focused on stopping haemorrhage, replacing lost blood and identifying the source of bleeding.

That means blood availability, objective measurement of blood loss, rapid response, trained health workers, emergency drugs and functioning referral systems.

The Africa CDC review suggests that these are not isolated problems.

Maternal mortality across African Union member states fell by 42 per cent between 2000 and 2023, from 666 to 388 deaths per 100,000 live births.

But the pace of decline remains insufficient to meet the Sustainable Development Goal target of fewer than 70 maternal deaths per 100,000 live births by 2030.

Africa CDC estimates that, if the current annual reduction of 2.4 per cent continues, the continental maternal mortality ratio would still be about 330 deaths per 100,000 live births in 2030 — close to five times the global target.

The report says achieving the target would require the rate of decline to increase roughly ten-fold.

The burden is also uneven.

West Africa records a maternal mortality ratio of 682 deaths per 100,000 live births and accounts for 55 per cent of maternal deaths on the continent.

Central Africa records 439 deaths per 100,000 live births, East Africa 260, Southern Africa 162 and North Africa 50.

Africa CDC says four of the five regions together account for 99 per cent of maternal deaths in Africa.

The evidence also points to failures that occur after a woman has reached a health facility.

Africa CDC identifies delays in receiving appropriate care, shortages of medicines and blood, staffing gaps and weak referral systems among factors contributing to maternal deaths.

Among countries that assessed whether maternal deaths could have been prevented, the estimated proportion of avoidable deaths ranged from 58 to 96 per cent.

The review also found gaps in acting on lessons from previous maternal death reviews.

Of 34 African Union member states whose maternal death review reports were examined, only 14 reported progress on recommendations from earlier review cycles.

“Only one country both analysed the three types of delay, assessed whether deaths were avoidable and tracked implementation of previous recommendations,” the report says.

It is against this backdrop that countries such as Tanzania and Rwanda are being highlighted in the Africa CDC review as examples of how improvements in referral systems, financing and quality of care have been associated with reductions in maternal deaths.

Tanzania’s progress is striking.

The country’s maternal mortality ratio fell from 556 deaths per 100,000 live births in 2016 to 104 in 2022, an 80 per cent reduction in seven years.

Over the same period, births taking place in health facilities increased from 51 per cent in 2015 to 81 per cent in 2022.

The success in Tanzania is attributed to stronger political commitment, expansion of Emergency Obstetric and Newborn Care facilities, growth in the health workforce, strengthened obstetric referral networks, capacity building and mentorship, as well as maternal and perinatal death reviews and surveillance.

Tanzania has also used the m-Mama emergency referral system to help pregnant women and newborns with complications reach appropriate care faster. The country is now being positioned as a continental learning and convening hub for maternal and child health.

Representing President Samia Suluhu Hassan at UNGA81, Vice President Deogratius John Ndejembi said Tanzania’s experience showed what could happen when political commitment was connected to practical investment.

“When we invest in feasible projects, and remain people-centred, development can move from promises to measurable results.”

He said Tanzania had recorded an 80 per cent reduction in maternal deaths over seven years, while facility births had risen from 51 per cent to 81 per cent.

“We, therefore, urge the international community to join us in giving this agenda a push.”

The wider continental push is also being linked to primary healthcare.

At the Second International Primary Health Care Conference in Arusha, African health leaders adopted the Arusha Call for Action, describing primary healthcare as the “delivery gateway” through which Africa’s health and development ambitions must pass.

The declaration calls for sustainable health financing, improved quality of care and stronger accountability.

Rwanda is also cited by Africa CDC as an example where improvements in referral systems, financing and quality of care have been associated with reductions in maternal deaths. The agency cautions that country examples in the review are not rankings, but are intended to illustrate approaches that may offer lessons for other countries.

Ghana provides another example of the importance of ensuring women have access to skilled care during childbirth, although coverage and outcomes vary across regions.

For Kenya, the continental findings have direct relevance.

Kenya launched its Every Woman Every Newborn Everywhere Acceleration Plan for 2026–2028, targeting preventable maternal and newborn deaths in 26 high-burden counties.

The Government says it is investing about Sh12.5 billion in maternal and newborn health, including Sh4 billion for delivery and essential newborn care, Sh1 billion for lifesaving commodities, Sh2.5 billion for family-planning commodities and Sh5 billion annually for the recruitment of 5,000 nurses.

The national plan also targets stronger emergency referrals, skilled care and accountability, with a six-month Rapid Results Initiative focused on the 26 counties.

Principal Secretary for Medical Services Dr Ouma Oluga has said maternal and newborn survival requires action beyond the health ministry.

“The survival of mothers and newborns is a shared responsibility across government. Every sector has a role in addressing the barriers that prevent women and newborns from accessing timely and quality care,” Oluga said.

That challenge mirrors the wider continental findings.

Africa CDC says maternal and newborn mortality remains concentrated in a minority of African Union member states, with wide differences between countries and regions.

The child survival picture is stark.

An estimated 4.9 million children died before their fifth birthday globally in 2024, including 2.3 million newborns, according to the latest United Nations child mortality estimates. Sub-Saharan Africa accounted for 58 per cent of global under-five deaths.

Newborn deaths accounted for nearly half of all under-five deaths globally, with complications from preterm birth and complications during labour and delivery among the leading causes.

The figures help explain why the Three Zeros agenda has been placed at the centre of Africa’s discussions at UNGA81.

According to Dr Miskellah, the numbers ultimately come down to what happens when a woman develops a complication.

“No mother should die because a facility lacked the basics,” he says.

Phyllis had reached a hospital.

She had delivered a healthy baby.

But when the emergency came, her family encountered the very gaps that health experts and Africa CDC are now warning about: the need for rapid recognition, blood, emergency treatment, skilled personnel and effective referral systems.

Phylis’ death puts the discussions in New York into a human context. The challenge for African health systems is not only to know what can prevent maternal deaths, but to ensure that the blood, medicines, skilled personnel, emergency referrals and rapid response are available when a woman needs them.

For Joseph, that response came too late.