Safe blood for safe motherhood

On the occasion of World Blood Donor Day, the theme of which this year is "Safe blood for safe motherhood", WHO is launching a new initiative to improve the availability and use of safe blood to save the lives of women during and after childbirth.

The initiative is the beginning of a broader blood safety agenda redefined in Ottawa this week and aims to work towards universal access to safe blood transfusion in support of the Millennium Development Goals (MDGs).

WHO is also releasing data collected from 172 countries on trends in blood donation, access and testing.

Globally, more than 500 000 women die each year during pregnancy, childbirth or in the postpartum period – 99% of them in the developing world. About 25% of those deaths are caused by severe bleeding during childbirth, making this the most common cause of maternal mortality.

Severe bleeding during delivery or after childbirth contributes to around 34% of maternal deaths in Africa, 31% in Asia and 21% in Latin America and the Caribbean.

As pregnant women are one of the main groups of patients requiring blood transfusion in developing countries, together with children they are particularly vulnerable to blood shortages and to HIV, hepatitis B and hepatitis C infections through unsafe blood.

"If current trends continue, the world will fail to meet target 5 of the MDGs to reduce maternal mortality," said Dr Margaret Chan, WHO Director-General. "We must do everything we can to improve the chances of women during and after childbirth."

Key life-saving intervention

Blood transfusion has been identified as one of the eight key life-saving interventions in healthcare facilities providing emergency obstetric care. Timely, appropriate and safe blood transfusion during and after labour and delivery can make the difference between life and death for many women and their newborns.

The Global Initiative on Safe Blood for Safe Motherhood aims to improve access to safe blood to manage pregnancy-related complications as part of a comprehensive approach to maternal care. This includes good antenatal care, prevention and timely treatment of anaemia, assessment of the need for transfusion and safe blood transfusion given only when really required.

WHO will strengthen the capacity of blood banks and district hospitals for improving maternal health through the provision of technical support in the areas of voluntary blood donation, safe blood collection, quality assured testing and best clinical practices. WHO will train clinicians, nurses, technicians and other key health personnel at district level facilities through its regional networks across the world.

The lack of access to safe blood for women reflects the general situation in developing countries. Developing countries are home to more than 80% of the world's population, yet they currently represent only 45% of the global blood supply.

Out of 80 countries that have donation rates of less than 1% of the population (fewer than 10 donations per thousand people), 79 are in developing regions; it is generally recommended that 1-3% of the population give blood to meet a country's needs.

Progress towards safe blood supply

The WHO survey, conducted in 172 countries covering 95% of the world's population and based on 2004 data, shows that some progress has been made since the beginning of the millennium towards ensuring a safer, more adequate supply of blood.

One of the survey's indicators was the implementation of voluntary, unpaid blood donation, which remains a mainstay of WHO recommendations to ensure a safe and sufficient blood supply.

In 2004, 50 countries had achieved 100% voluntary unpaid blood donation, compared with 39 countries in 2002. Three of the 11 new countries achieving this are categorized as least developed. More and more countries are moving towards voluntary blood donation. In 2002, 63 countries were collecting less than 25% of their blood from voluntary unpaid donors. By 2004, this had fallen to 46 countries.

Testing of blood for major infections such as HIV/AIDS, hepatitis B and C is also increasing, although in many countries there are few indicators showing if the testing is carried out according to quality assured procedures.

Out of 40 countries in sub-Saharan Africa, 28 countries have yet to establish national quality systems. Of 148 countries (28%) that provided data on screening for transfusion-transmissible infections, 41 were not able to screen the donated blood for one or more of the markers.

From 9 to 11 June, Ottawa was the venue for a global consultation organized by WHO with the collaboration and support of the Government of Canada and the Canadian and French blood services. Around 100 experts in transfusion called on governments, international agencies and nongovernmental organizations to work together towards universal access to safe blood transfusion by 2015 in support of the MDGs to reduce maternal and child mortality and prevent the transmission of HIV, hepatitis and other life-threatening infections through unsafe blood and blood products.