New Delhi: Postpartum haemorrhage (PPH), excessive bleeding after childbirth, remains one of the leading causes of maternal deaths worldwide, affecting an estimated 27 million women each year. A new Lancet Series published in June 2026 highlights the role of caesarean births in this burden, reporting that nearly one-third of all PPH cases occur during or after surgical deliveries.
According to the Series, postpartum haemorrhage occurs in 12.6% of vaginal births but rises to 30.9% of caesarean births. Of the estimated 27 million PPH cases recorded globally every year, around 10 million are associated with caesarean delivery.
The authors note that while caesarean sections are essential and often life-saving when medically indicated, they also carry a substantially higher risk of severe bleeding than vaginal births.
Why the risk is higher
The review identifies several reasons why caesarean deliveries increase the likelihood of postpartum haemorrhage.
During a caesarean section, the uterus is surgically opened, which can reduce its ability to contract effectively after birth. Poor uterine contraction, known as uterine atony, is the most common cause of postpartum haemorrhage. Surgery also increases the possibility of injury to blood vessels and surrounding tissues.
Women undergoing caesarean births are also more likely to have conditions that raise the risk of bleeding, including previous caesarean deliveries, multiple pregnancies, pre-eclampsia, obesity and anaemia. Previous caesareans can also increase the likelihood of abnormal placental attachment in future pregnancies, further increasing the risk.
A preventable cause of maternal deaths
The Series describes postpartum haemorrhage as a largely preventable condition when recognised and treated early. However, delayed diagnosis, inadequate access to emergency care and inconsistent implementation of evidence-based practices continue to contribute to maternal deaths.
Beyond immediate blood loss, severe postpartum haemorrhage can result in blood transfusions, emergency hysterectomy, organ failure, long-term physical complications and psychological distress. The researchers estimate that the condition also imposes a global economic burden of approximately US$10.4 billion annually.
Reducing unnecessary c-section
Among the measures highlighted in the Series is the need to avoid caesarean sections that are not medically necessary.
The authors identify unnecessary caesarean delivery as a missed opportunity to reduce postpartum haemorrhage. Although the procedure remains an essential intervention in complicated pregnancies, they note that every avoidable surgical birth exposes women to additional risks without corresponding medical benefit.
The findings add to ongoing international discussions about the steady rise in caesarean rates in many countries, where the procedure is increasingly performed beyond clear medical indications.
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India’s rising caesarean section rates
The findings are particularly relevant for India, where caesarean section rates have increased steadily over the past decade.
While the World Health Organization recommends that caesarean deliveries account for about 10–15% of births, the National Family Health Survey (NFHS-5, 2019–21) found that 21.5% of births in India were by caesarean section, up from 17.2% in NFHS-4 (2015–16).
The trend has continued in recent years. According to data presented by the Union Health Ministry in Parliament, caesarean deliveries accounted for 27.46% of all reported births in 2024–25, compared with 25.27% in 2023–24.
The increase is driven largely by the private healthcare sector, where nearly one in two births is by caesarean section. In comparison, public hospitals report rates of around 14–16%. State-level differences are also pronounced. Telangana recorded a caesarean rate of more than 60% in NFHS-5, while Nagaland reported fewer than 6%.
Earlier recognition can save lives
The Series also highlights recent changes in how postpartum haemorrhage is identified.
The World Health Organization now recommends recognising PPH earlier by defining it as blood loss of 300 mL accompanied by signs of cardiovascular instability, or 500 mL regardless of symptoms, whichever occurs first. The revised definition aims to encourage earlier treatment before bleeding becomes severe.
The researchers recommend several interventions to reduce maternal deaths, including:
- Routine use of uterotonic medicines after every birth to help the uterus contract.
- Additional preventive medications for women at high risk.
- More accurate measurement of blood loss instead of visual estimation.
- Better screening and treatment of anaemia during pregnancy.
- Improved access to quality maternity care and emergency obstetric services.
The authors also point to the WHO Postpartum Haemorrhage Roadmap 2023–2030, which outlines strategies to strengthen prevention, diagnosis and treatment worldwide.
Prateeksha Kumari is a journalist and strategic communications professional specialising in digital journalism, political reporting, and public affairs. Her work focuses on grassroots issues, governance, and civic developments, with an emphasis on clarity, accuracy, and narrative-driven reporting.
She holds a Master’s degree in Journalism and Mass Communication from Himachal Pradesh University, Shimla and has qualified the UGC-NET examination, reflecting her academic grounding in media studies and communication research. Her reporting spans politics, public policy, health, education, and socio-economic issues, and she is experienced in bilingual (Hindi and English) content creation tailored to diverse audiences.
Alongside her journalistic work, she brings experience in political communication and public relations, where she has contributed to campaign messaging, media outreach, and narrative building. She has worked on integrated communication strategies across print and digital platforms, combining editorial judgment with audience insight and data-led content approaches.
