Each year, more than 260,000 babies die or suffer lifelong disabilities from Rh disease, a completely preventable condition. These deaths and disabilities happen simply because basic care never reaches the women who need it. Despite decades of medical knowledge, approximately half of pregnant women globally who require anti-D treatment actually receive it.  

Rh disease occurs when a mother’s blood type is incompatible with her baby’s. We all have a major blood type: A, B, AB, or O. Most people also have the Rh factor on a small protein on the surface of their red blood cells; this protein determines whether your blood type is positive or negative (for example, A+ or O-).

If a mother does not have the Rh factor (she is “Rh-negative”), but if her baby does (he or she is “Rh-positive”), her immune system can react to the baby’s red blood cells as if they are a threat. The mother’s immune system creates antibodies to the Rh factor that cross the placenta and begin to attack the fetus’ red blood cells. This immune response can lead to dangerous and sometimes fatal complications.

Without preventive care, Rh disease can cause:

• Severe anemia (dangerously low red blood cell levels)
• Fluid buildup in the fetus (hydrops fetalis)
• Brain damage caused by lack of oxygen
• Stillbirth or death shortly after birth
• Jaundice after birth, which can lead to brain damage

Even when babies survive, many are left with lifelong disabilities. The effects ripple outward. Mothers can experience the trauma of pregnancy loss, the challenges of raising a child with complex medical needs, and the emotional burden of stigma, abandonment by partners, and isolation from their communities.

Rh disease is not a mystery, we know how to prevent it. And we do prevent it every day in well-resourced medical systems. With simple blood tests and timely treatment, no family should have to face these outcomes. The knowledge, prevention and treatment exist, and Rh disease is effectively preventable. Yet, millions of women in low-resource regions still lack access to this basic care. What is missing is awareness and access.

WIRhE is working to close these gaps and end these preventable tragedies, once and for all.

In high-income countries, Rh disease has become rare, not because the disease itself has gone away, but because access to routine preventative care has made it almost disappear.

During early pregnancy, women are tested to determine their major ABO blood type and Rh status. If a woman is Rh-negative, her care team knows there may be a risk, especially if her fetus is Rh-positive.

To prevent Rh disease, she receives an injection of anti-RhD immunoglobulin around 28 weeks of pregnancy. This simple, highly effective treatment prevents her immune system from making antibodies to RhD that could harm her baby.

The mother also receives a second dose after birth if her baby is Rh-positive, a critical step that protects future pregnancies. Additional doses may also be needed if she experiences bleeding, miscarriage, or certain medical procedures during pregnancy.

Postnatal prophylaxis, introduced over 50 years ago, was the breakthrough that caused RhD-related fetal and neonatal deaths to plummet in high-income countries.

Thanks to these straightforward steps, Rh disease is now almost unheard of in high-income countries. However, before anti-RhD immunoglobulin was widely available, Rh disease claimed the lives of up to 400,000 babies every year.

Finally, the science has not changed for more than 50 years — access has. Now it is time to close the gap, so all mothers, everywhere, can get the same timely care that prevents this tragedy.

In many parts of Africa, South Asia, and Latin America, Rh disease is still a major cause of newborn death and stillbirth. In these areas, many pregnant women never receive the basic blood test that would tell them if they even are at risk. Even when they do know their Rh status, the medicine that prevents Rh disease, called anti-RhD immunoglobulin, is often not available, too expensive, or not given at the right time.

Crucially, the postnatal dose — the primary one that offers long-term protection — is often missed. For example, a recent study from our partners in Ethiopia found that some women were given this therapy during pregnancy but not after their babies were born. This missed step can lead to serious future complications.

When a woman does not receive the right care, her immune system may start to see Rh-positive babies as a threat. Once this happens, every subsequent pregnancy with an Rh-positive baby is at risk. Each one is usually more dangerous and more affected than the last. Some women have gone through five, six, or even nine miscarriages because they were not protected.

When prevention is not available, special care is needed to try to save the baby. This includes:

• Regular blood tests to check for warning signs
• Ultrasounds to look for signs of anemia
• Blood transfusions given to the fetus before birth
• After birth, treatments like phototherapy and more blood transfusions

But in many low-income countries, these treatments are either not available or cost far more than families can afford.

The impact on mothers is heartbreaking. Without the right tests, treatment, or even information, they have little control over their pregnancies. Many are unfairly blamed for poor outcomes. Some are abandoned by partners or pushed away by their communities.

This should not be happening. This is a preventable injustice.

Every mother deserves access to the care that can save her baby’s life; where you live should not determine whether your baby lives or dies.

Despite decades of medical knowledge, approximately half (50%) of pregnant women globally who require anti-D treatment do not receive it. Some reasons for this shortage can be attributed to:

• Lack of awareness
• Lack of supply
• Lack of local production
• Not affordable