What the WOMAN Trials Revealed About Anaemia, Postpartum Haemorrhage and Maternal Death

Why It Matters

Anemia is a hidden driver of postpartum death; early detection and treatment could halve maternal mortality in low‑income regions.

Key Takeaways

• Tranexamic acid saves one‑third of postpartum hemorrhage deaths if given early.
• WOMAN‑2 trial showed no benefit of tranexamic acid in anemic women.
• Moderate/severe anemia causes fatal outcomes even with modest bleeding.
• Nutritional anemia prevalent in Sub‑Saharan Africa and South Asia due to poverty.
• Early anemia screening and treatment essential to reduce maternal mortality.

Summary

The video details findings from the WHO‑sponsored WOMAN trials, which examined tranexamic acid (TXA) as a treatment and preventive measure for postpartum hemorrhage (PPH) in low‑resource settings.

The original WOMAN trial enrolled about 20,000 women across Africa and South Asia and showed that TXA given within three hours of bleeding cut PPH‑related mortality by roughly one‑third. A follow‑up WOMAN‑2 study targeting anemic mothers, however, found no reduction in bleeding or death, revealing that anemia drives fatal outcomes even when blood loss appears modest.

Professor Nik Belu recounts a harrowing delivery in Nigeria and shares Sana’s story from Pakistan, illustrating how severe nutritional anemia, cultural food bias, and lack of antenatal care leave women vulnerable. He notes that women often dismiss menstrual blood loss as normal, missing early signs of iron deficiency.

The results compel policymakers to prioritize anemia screening before pregnancy, expand iron supplementation, and fund the upcoming WOMAN‑3 trial that will test combined iron and TXA therapy. Without such interventions, maternal mortality will remain disproportionately high in the world’s poorest regions.

Original Description

Maternal mortality remains one of the most pressing challenges in global health. Although efforts over the past decades have reduced death rates, progress has slowed – particularly in sub-Saharan Africa and South Asia, where most maternal deaths occur.

This film presents the missing evidence which suggests anaemia may be the hidden factor driving maternal deaths. It shares insights from the clinicians who run the WOMAN Trials and collected the data, as well as powerful personal accounts from women in Pakistan, Nigeria and Tanzania.

It calls for global action to reduce the prevalence and severity of anaemia in women and adolescent girls, with the ultimate aim of reducing maternal deaths.

What this video covers

- Why postpartum haemorrhage remains a leading cause of maternal death

- What the WOMAN and WOMAN‑2 trials discovered about tranexamic acid

- Why anaemia puts women at extreme risk – even with “normal” blood loss

- How poverty, nutrition, gender norms, and lack of antenatal care fuel the crisis

- The generational impact of untreated anaemia

- What the upcoming WOMAN‑3 trial aims to uncover

Read more: thebloodtrials.org/the-missing-evidence/

Timestamps

00:00 — Introduction

01:12 — Who is Professor Nike Bello?

01:27 — Why postpartum haemorrhage kills so quickly

02:37 — The WOMAN Trial

03:11 — The WOMAN‑2 Trial and unexpected results

04:13 — Why anaemia changes everything

05:00 — Listening to women’s stories

06:10 — Why anaemia is widespread in South Asia and sub-Saharan Africa

08:23 — Nutritional anaemia and poverty

10:22 — Menstruation myths and missed diagnoses

11:09 — Sana’s story

12:36 — What the trials mean for the future

13:41 — The WOMAN‑3 Trial

14:16 — A message to policymakers and clinicians