The deadly cost of Kenya's blood shortage in delivery rooms

Joseph Wanyonyi eagerly prepared to welcome his newborn on September 9, 2025.

He walked his wife, Phylis Wanjiru, to a private hospital where she was wheeled into theatre for delivery.

Moments later, the couple’s joy was complete when Wanjiru safely delivered their fifth child through Caesarean Section (CS). They cuddled the newborn in celebration.

But the happiness was short-lived.

Soon after delivery, Wanjiru, 32, began to experience severe internal bleeding (post-partum haemorrhage-PPH) due complications of the uterus.

Unfortunately, the hospital did not have blood in stock to transfuse her. For approximately seven hours, she bled.

Wanjiru was eventually referred to Kenyatta National Hospital (KNH) for urgent management.

At KNH, doctors immediately transfused her with four pints of blood and rushed her to theatre for re-exploration (a second surgery to stop the bleeding), and would receive an extra pint during surgery.

Though the surgery was a success, doctors said she was developing heart failure because of low blood levels.

Wanjiru was moved to Intensive Care Unit (ICU) as the medical team mobilised more blood for transfusion.

“Doctors told me my wife urgently needed more blood,” Wanyonyi recalls. “I hurriedly went on my Xspace to mobilise donors, and as friends responded to the call, I received heartbreaking news- my wife had died.”

Wanyonyi’s world shattered.

“I lost my wife because blood did not arrive on time. I wish I had solution,” he narrates with a heavy heart.

He adds: “I am angered even more because at the private hospital, a doctor who operated on my wife said he could not have predicted that she was going to bleed. The hospital had no blood.”

A medical record shows Wanjiru developed complications that required re-exploration to manage the bleeding and “was referred because of lack of blood.”

Now left to raise their newborn and four other children alone, Wanyonyi wishes the life-saving commodity had been available to save his wife.

Wanyonyi is now calling for accountability and justice for his wife’s death.

The case is not an isolated one. Studies reveal 40 to 50 per cent of women who suffer PPH die, among them 25 per cent who do not get blood.

“Facts on PPH are so alarming. It is a crisis. It’s not just about health of a mother, but their babies, other children, the husband and anyone who depended on her,” says Julius Ogeng’o, a professor of human anatomy at the University of Nairobi, and maternal health advocate.

Blood, he says, is a drug that saves the lives of mothers and newborns at birth.

At Pumwani Maternity Hospital, the country’s busiest maternity facility, between 20 and 40 pints of blood are transfused every single day. The facility delivers an average of 1,500 deliveries every day.

Since its accreditation as a satellite blood donation centre in June 2024, Pumwani has collected 4,300 pints, nearly meeting its quarterly target of 4,600.

The donations have been critical in saving the lives of mothers and newborns.

One of those lives is Mercy’s*. The 14-year-old girl from Zimmerman, Nairobi, had been admitted with dangerously low blood levels, her haemoglobin was just 8.2.

She was transfused with two pints before being wheeled into theatre for an emergency CS and given another pint after delivery.

Before the transfusion, Mercy endured severe headaches, dizziness, and weakness.

So naive about maternal care, she had visited the hospital for the first time when she noticed her belly was “swollen,” only to be told she was due for delivery.

“I had hidden my pregnancy, only to receive shocking news of having low blood levels. But more scary was when the doctor said I needed a CS. My heart raced. I knew it was a matter of life and death. I had hidden the pregnancy all along,” says Mercy.

The first time mother is grateful to the strangers who donated blood, giving her a second chance at life.

For Wolke Daiso, survival came by a whisker.

She was rushed to hospital with a ruptured uterus.

Doctors immediately transfused her with three pints of blood and worked tirelessly to stop the bleeding.

Sadly, her baby did not survive.

“I feel empty, carrying a pregnancy to term, only to have a stillbirth. But I thank God for saving my life,” she says.

Melan Nafula faced a similar ordeal. The 20-year-old also suffered a ruptured uterus with a concealed baby and was rushed to theatre in critical condition.

She received two pints of blood to stabilize her.

“I am thankful for those who donated blood to save my life. My baby died, but at least I am safe,” she says.

The stories of these women show that blood is key for the survival of mothers and newborns and that every pint donated gives a woman a fighting chance.

A visit to the delivery room established that PPH is measured using calibrated nylon papers to estimate blood loss in mothers within delivery rooms.

If blood loss approaches 500 ml and the mother is still bleeding, it signals that she is at risk of PPH, and quickly interventions are initiated, including administration of uterotonics such as oxytocin and carboprost, drugs that stop bleeding.

Nevertheless, if blood loss reaches 1,000 ml, it is treated as an emergency.

The mother is rushed to theatre to check for cervical tears, vaginal tears, or uterine rupture, which are then repaired.

Gauze swabs and pads are also used during examination to determine whether the mother has tears and to help identify the exact source of bleeding, and amount of blood loss.

If PPH is confirmed, additional drugs are administered, such as tranexamic acid and more oxytocin, to prevent further bleeding. If the bleeding continues, the case is established with surgical intervention performed if necessary.

“Blood is life. I have watched mothers die because there was no blood available. I remember one case, a mother with a ruptured uterus whose haemoglobin was just 2 grams per decimiter. She was paper-white. We lost both her and the baby because there was no blood for transfusion,” says, Rose Wanzetse, a nurse at the surgical ward.

Not only is transfusion done to adults, newborns admitted to the Neonatal Unit also require blood to save their lives.

Nurse Faith Njeru, the in charge of the unit explains that most babies transfused are preterm, suffering from anaemia of prematurity because their bodies are not fully developed.

Some babies at the wing have bleeding disorders or severe jaundice caused by their immature liver.

“If untreated, jaundice can cause brain damage, so we perform exchange transfusions using very fresh blood, a process that takes over five to six hours,” she says.

The neonatal unit has 150 beds, and more than half of the babies are preterm.

Dr Dorcas Supa, President of the Kenya Paediatric Association (KPA), adds that some babies are born with low blood levels because there was not enough time for blood to flow from the placenta before the cord was cut.

Such babies may need a “top-up” transfusion soon after birth to stabilise them.

Blood group incompatibility, such as rhesus factor conflict also dictate transfusion in newborns, where antibodies from the mother destroy the baby’s red blood cells, causing severe jaundice soon after birth.

“Exchange transfusion in babies with jaundice is done, not just to raise blood levels but to remove the harmful antibodies and replace the baby’s blood with one free of them,” explains Dr Supa.

Preterm babies are at high risk of anaemia because they miss iron stores transferred in late pregnancy, leaving them unable to make enough blood. Newborns may also develop bleeding in the brain from prematurity, lack of oxygen, or birth trauma, all of which can require transfusion.

Haemorrhagic disease of the newborn also necessitates transfusion. To prevent the condition, every newborn is given Vitamin K at birth.

“Babies with severe infections also suffer lower platelets, forcing doctors to transfuse blood components,” says Supa.

However, the expert says there is a need to package paediatric blood in smaller volumes, unlike current 500 ml bags that result in wastage as newborns need very small volumes.

Supa emphasises that the health of a mother directly affects newborns’ blood levels. “By improving mothers’ haemoglobin during pregnancy, we reduce the risk of anaemia in babies and minimise the need for transfusion,” she says.

Prof Moses Obimbo, an obstetric gynaecologist at the University of Nairobi, regrets of increase in cases of maternal mortality, whose causes are multifactorial, for instance, lack of expertise in conducting deliveries, more so CS. He says some hospitals lack resources needed to manage deliveries, such as drugs to make the uterus contract like tetronics, putting women in danger.

Other contributors to deaths include high pressure at birth, pre-eclampsia, infections and obstetric labour.

The scientist explains that blood is an important component in pregnancy, but 40 per cent of women who are in the first trimester of pregnancy do not have enough blood.

“A woman with low blood levels worsens as the pregnancy grows, because the baby pulls everything from mother during pregnancy predisposing her to incidences like PPH, pre-eclampsia and sepsis infections,” says Obimbo.

He explains that when a woman is about to deliver, 700 to 800 ml of blood goes through the uterus.

For four to five minutes, the entire volume of blood passes through the uterus, leaving only 30 per cent of blood shared among other organs.

“If there is another cause that results into excessive bleeding a woman can therefore die within 10 to 20 minutes if intervention is not done because they loses 700 ml of blood every minute, if you have no blood to transfuse, within 20 minutes, the woman will be dead,” he explains.

Prof Obimbo adds: “A bleeding women cannot walk, and mobilise blood. Even relatives cannot help in any way- they can just watch. That’s why blood should always be available to save lives.”

He explains that at birth, if a woman is losing blood, a doctor manages her so that she does not lose more, and she is transfused.

Transfusion ensures the patient retains enough volumes for her heart to pump because kidneys, brain, heart and other organs are maintained sufficiently with enough volume of blood.

“If a woman does not have blood and is not transfused, she can suffer from organ failure because they do not have blood,” says Obimbo.

As a transfusion is done, doctors identify the cause of bleeding.

“For any woman heading for delivery, cross match is done with two units of blood expected but those bleeding excessively, it depends on amount they’re losing. For example, if she loses three pints, she will require three pints for management,” explains the expert.

In delivery rooms, a drape is used to measure amount of blood in litres. Loss of 500 millimetres of blood is considered excessive bleeding for normal deliveries, and 1,000 millimetres for CS.

“Good volume of blood to every pregnant woman should be above 11 grams per decilitre (11 HB),” he advises.

Doctors and midwive,s in collaboration with Ministry of Health have joined the movement of ending PPH by ensuring there is adequate blood to support women in maternity wings across the country, through roaming blood banks.

The initiative will mobilise resources to get a big cohort of over 100,000 people who shall be called upon to donate blood.

Kenya faces a persistent blood shortage that leaves thousands of patients at risk every year, with Nairobi, the country’s busiest health hub collecting only 60 per cent of its annual target.

The country heavily relies on schools to replenish stocks, contributing to 70 per cent of Nairobi’s blood supply. 

Nairobi County is expected to collect 50,000 pints annually but manages just 38,000 pints in 2024/25, according to Nairobi County Blood Transfusion Coordinator Denis Oduor.

“Blood should be waiting for the patient, not the patient waiting for blood,” says the coordinator who doubles up as blood mobiliser, a mission aimed at ensuring no one dies because of lack of blood.

Data reveals maternity and newborns consume highest amount, with nearly half of transfusions taking place in maternities, theatres and pediatric emergencies.

Initially, blood services were heavily funded by donors, but since they pulled out, counties are not allocating a budget for blood collection, screening, distribution and logistics.

“The Ministry of Health and Kenya National Blood Transfusion and Transplant Services (KBTTS) provides blood bags and other donor commodities but demand and supply are not synchronised” says Oduor.

Further, KBTTS encourages regular blood donation to save lives.

“You cannot buy blood in pharmacy, chemists or procure through Kemsa. It must be donated. Kenyans must normalise blood donation so that when emergencies happen, patients get instant blood, and not wait for it,” emphasises Oduor.

Dr Laura Oyiengo, health specialist, maternal and newborn health, UNICEF Kenya, notes that Kenya has best policies on blood donation and collection centres, but adults do not donate blood.

“The problem in this country is we depend too much on students in universities and high schools to donate blood,” says Laura, also a paediatrician.

Dr Laura notes it is high time adults who are healthy, aged between 18 to 65 years become regular blood donors to save lives.

“It is sad that when schools close, there is usually a crisis of blood not being available. Let’s have a culture of Kenyans donating blood. Let us not wait until we make an appeal. Its stressful mobilising blood for a sick relative, when they should be treated,” says Dr Laura.

Laura further encourages individuals to know their blood group, more so pregnant women.

“There is need for them to undergo regular check-ups to know their blood level, and eat a balanced diet and food rich in iron to avoid being anaemic,” encourages Laura.