Maternal and newborn care is one of the biggest challenges in international health. Women and infants die every day in the developing world from preventable causes - most of which are virtually nonexistent in the Western hemisphere. It is tragic when you hear about an 18-year-old girl who dies due to eclampsia, or a mother of two who dies from postpartum hemorrhage (excessive bleeding after birth). It's unacceptable - and in many ways shameful for the international health and development community - for women to die from preventable and manageable illnesses and conditions. 

Deji, a Nigerian nurse-midwife, shared some of her experiences with me during my recent trip to Pathfinder International project sites in Nigeria. At Murtala Muhammad Specialist Hospital, which has a maternity ward that conducts around 13,000 deliveries a year, Deji did not have immediate access to a blood bank if one of her patients needed blood. If a woman was suffering from severe bleeding post-childbirth (25 percent of maternal deaths are caused by postpartum hemorrhage) she would have to take a blood sample from the woman, wait for the results (usually 20-30 minutes), then look for donors. Deji said husbands would often have to pay someone to donate blood to save their wives. Such commercial blood is not only more expensive, but usually has a higher risk for transmitting HIV than blood donated by a volunteer. Imagine the difficulties involved in finding a donor that not only matches you wife's blood type, but is screened for HIV - all while under the duress that her life is at risk. By the time a woman receives a transfusion it could be more than five hours-and that's a modest estimate. Deji would see women die for no other reason but that they lacked access to a blood supply.  

Unfortunately availability of emergency blood is not commonly practiced in the developing world - and sub-Saharan Africa in particular - due to cultural, physical, and/or resource barriers. But with the right systems and training, many of these barriers are addressed and emergency blood made available. For instance, at Murtala Muhammad, Deji was extremely enthusiastic that the hospital saw the opening of a new blood bank which will provide much needed blood supplies for the maternity ward. Opened this past January at the impetus of a Pathfinder maternal care project, the new blood bank was named in honor of a longstanding, dedicated OB/GYN Dr. Habib Sadauki (who also directs Pathfinder International's Continuum of Care: Addressing Postpartum Hemorrhage project). The blood bank will address one of the critical delays in ensuring maternal survival and care. 

In addition, at another Pathfinder project site in rural Nigeria I noticed an interesting change. Immediately after a local hospital received training and support to maintain an emergency blood supply, the Medical Officer in charge initiated a system for emergency blood. He set aside at least four pints to be available for maternal emergencies at all times. This may seem a small amount, but it is a big achievement for this rural hospital. If every rural hospital adopts such a strategic intervention, then women who arrive at a hospital with postpartum hemorrhage could be saved much more quickly during this most critical of times.  

For the past twenty years, I have seen little change in worldwide statistics for maternal and newborn care. But it's time to put our collective foot down and call for zero tolerance to maternal death. No longer should women die during a time that should be one of celebration and hope. It is imperative that we rededicate ourselves to ending maternal mortality.  

Putting zero tolerance for maternal death into place - or to put it more positively - ensuring maternal and newborn survival, requires broad-ranging and innovative approaches. These include helping women access family planning to prevent unwanted and early pregnancies, managing emergency obstetric care, and involving communities in identifying and addressing their own community health needs. Already there are organizations - like Pathfinder - that are pursuing these changes. But it is going to take more.  

More attention needs to be paid to emergency obstetric and neonatal care. More funding is required in order to provide quality health services and change the dire circumstances many women face. And more pressure needs to be brought to bear on leaders to highlight this as a major issue going forward. But together I look forward to a new time of zero tolerance and more women being saved through such simple, yet vital, acts as accessible blood.