Every seven minutes, a Nigerian woman is estimated to die from complications related to pregnancy or childbirth, making the country the global epicentre of maternal mortality. While postpartum haemorrhage remains the single biggest killer of mothers, a simple, low-cost intervention backed by the Gates Foundation is beginning to change that grim reality. From dramatically improving the early detection and treatment of excessive bleeding after childbirth to delivering encouraging results in Kano State, the E-MOTIVE initiative is emerging as a promising model in Nigeria’s fight to reduce preventable maternal deaths. This report examines how the evidence-based intervention is reshaping maternal healthcare and why experts believe it could help reverse one of the country’s most persistent public health crises. Chiemelie Ezeobi reports Nigeria carries the heaviest maternal death burden of any country on earth. Global estimates put the country’s maternal mortality ratio at 1,047 deaths per 100,000 live births, with roughly 8,200 maternal deaths a year and a share of 28–29 per cent of all maternal deaths recorded worldwide, despite Nigeria holding only a small fraction of the global population. Some estimates put the annual toll closer to 75,000 deaths, which is about one every seven minutes as only 43 per cent of Nigerian births are attended by a skilled provider, and 59 per cent of deliveries still happen at home rather than in a health facility. Postpartum haemorrhage (PPH), severe bleeding after childbirth, is the single leading cause of these deaths, responsible for an estimated 27 per cent of maternal deaths globally. It is also one of the most preventable, if caught early enough. That premise is what sits behind E-MOTIVE, the Bill Gates Foundation-funded intervention now being credited with measurable declines in maternal deaths in the states where it has been rolled out. What E-MOTIVE actually is E-MOTIVE is not a new drug. It’s a change in clinical routine. It pairs a low-cost calibrated plastic drape, placed under a woman after delivery to objectively measure blood loss rather than relying on visual estimation, with a rapid, first-response treatment bundle: uterine massage, oxytocic drugs, tranexamic acid, IV fluids, examination, and escalation to higher care if needed (summarised by the acronym MOTIVE). E-MOTIVE is one of the simplest innovations in maternal healthcare is helping health workers identify postpartum haemorrhage before it becomes fatal. The E-MOTIVE protocol, now being implemented in several African countries, places early detection at the heart of preventing postpartum haemorrhage (PPH). Developed through research in countries with high maternal mortality rates, the protocol provides a set of evidence-based steps for managing excessive bleeding after childbirth. The first step—represented by the letter “E” in E-MOTIVE—is early detection. According to the foundation, recognising PPH quickly is often difficult, particularly in overcrowded maternity wards and low-resource health facilities where electricity and advanced monitoring equipment may be unavailable. Delays in identifying dangerous blood loss can cost mothers their lives. To address this challenge, the protocol recommends the use of the PPH drape, a simple but effective device that collects blood in a V-shaped plastic pouch marked with measurement indicators. Rather than relying on visual estimates, healthcare workers can accurately measure blood loss in real time, enabling them to recognise excessive bleeding early and begin life-saving treatment without delay. The approach was tested in a large, Gates Foundation-funded cluster-randomised trial (ClinicalTrials.gov: NCT04341662) conducted by the University of Birmingham with WHO’s reproductive health research arm (HRP). The trial ran across 80 secondary-level hospitals in Nigeria, Kenya, South Africa, and Tanzania, enrolling more than 210,000 women who underwent vaginal delivery. What the Trial Found The published results, since carried in The Lancet and reported by the research consortium, were striking: use of the calibrated drape lifted PPH detection rates from 51 per cent to 93 per cent. Adherence to the WHO-recommended treatment bundle rose from 19 per to 91 cent. The combined intervention produced a 60 per cent reduction in severe PPH and its associated adverse outcomes (severe bleeding, laparotomy for bleeding, or death from bleeding). Median blood loss, need for postpartum blood transfusion, and maternal deaths were all reduced in intervention hospitals compared with hospitals providing usual care. A follow-up nested study within the trial also looked at how fast PPH was actually being caught on the ground. In Nigeria and Tanzania, the median time from birth to PPH diagnosis was 15 minu
Don't miss out on breaking stories and in-depth articles.
