Scaling up Interventions for Postpartum Haemorrhage in Nigeria 

Postpartum haemorrhage (PPH)—severe bleeding after childbirth—is a leading cause of maternal deaths worldwide, claiming over 70,000 lives each year. In Nigeria, where maternal mortality remains alarmingly high, PPH accounts for nearly a quarter of all maternal deaths. Many of these fatalities occur due to delayed recognition, inadequate treatment, and limited access to essential medical interventions. It was to tackle this crisis that the World Health Organisation (WHO) introduced the E-MOTIVE strategy, a life-saving approach focused on early detection and timely intervention. By using simple yet effective measures—such as calibrated blood-collection drapes for accurate blood loss assessment and a first-response treatment bundle—E-MOTIVE has been proven to reduce severe PPH cases by 60 per cent in clinical trials across Africa. While with proper implementation, it could drastically cut maternal deaths in Nigeria, ensuring that no woman loses her life while bringing another into the world, Chiemelie Ezeobi writes that urgent action is needed to scale up this intervention and make maternal health a national priority

When 27-year-old Amina Yusuf went into labour, she was filled with excitement. After months of anticipation, she was finally about to meet her baby. But what should have been a moment of pure joy quickly turned into a nightmare. 

Shortly after delivering her son at a small clinic in Kaduna, Amina began bleeding profusely. The nurses, ill-equipped to handle such an emergency, did what they could—pressing on her abdomen and administering local herbs while her husband frantically searched for help. 

By the time he returned with a doctor, Amina was gone. She had succumbed to postpartum haemorrhage (PPH)—a silent killer that claims the lives of thousands of Nigerian women every year.

Amina’s story is not an anomaly. It is the tragic reality faced by many families across Nigeria. The birth of a child should not be a death sentence for the mother, yet, with every passing day, women like Amina continue to die from a condition that is both preventable and treatable.

The Silent Epidemic of Postpartum Haemorrhage

Postpartum haemorrhage is defined as excessive bleeding of more than 500 millilitres following vaginal delivery or more than 1,000 millilitres after a caesarean section. It can occur within minutes after childbirth or up to 12 weeks postpartum. The most common cause is uterine atony—the failure of the uterus to contract effectively after delivery—though other factors, including retained placental tissue, birth trauma, and clotting disorders, also contribute.

Globally, approximately 14 million women experience PPH every year, and 70,000 of them die as a result. According to Prof. Hadiza Galadanci, Director of the Africa Centre of Excellence for Population Health and Policy at Bayero University, Kano, PPH accounts for 25 per cent of all maternal deaths worldwide.

In Nigeria, the statistics are even more harrowing. The country has the highest number of maternal deaths globally, with a maternal mortality ratio (MMR) of 512 per 100,000 live births. 

This means that for every 1,000 live births, approximately five women do not survive. In 2015 alone, Nigeria recorded 58,000 maternal deaths, with PPH responsible for nearly a quarter of them. The risk is further exacerbated by widespread anaemia, affecting 41.8 per cent of pregnant Nigerian women, making them more vulnerable to excessive bleeding.

Why Are Nigerian Mothers Dying from PPH?

Several interwoven factors contribute to Nigeria’s alarmingly high maternal mortality rate including: Inadequate Healthcare Infrastructure, which has seen many women give birth in poorly equipped health centres or at home, without access to skilled birth attendants as rural areas, in particular, lack essential medicines, blood transfusion services, and trained personnel.

Another challenge is the Delayed Detection and Treatment, which has seen many health facilities lacking the necessary tools to measure blood loss accurately, leading to delays in recognising excessive bleeding. Expectedly, without immediate intervention, PPH can quickly become fatal.

Not to be left out are Cultural and Societal Barriers, which has seen many women, especially in rural communities, opt for home births due to cultural beliefs, religious convictions, or a lack of trust in the healthcare system. Traditional birth attendants (TBAs), who lack the training to handle obstetric emergencies, are often the only caregivers available.

Most importantly, the issue of Financial Constraints has been a burden. With over 40 per cent of Nigerians living below the poverty line, many families cannot afford hospital deliveries. The high out-of-pocket costs discourage pregnant women from seeking professional medical care.

On the issue of Lack of Blood for Transfusions, even when women make it to a hospital, a critical shortage of blood donations means that many patients do not receive life-saving transfusions in time. Nigeria’s blood donation rate is far below the WHO-recommended level, leaving a gap that costs lives daily.

E-MOTIVE: A Lifeline for Nigerian Mothers

Recognising the urgent need for effective interventions, the World Health Organisation (WHO) developed the E-MOTIVE strategy, which focuses on early detection and prompt treatment of PPH. This approach has been tested and proven effective in reducing maternal deaths.

The E-MOTIVE package includes Early detection-Using a calibrated blood-collection drape to accurately measure blood loss, ensuring PPH is identified in real time. Also, the First-Response Treatment Bundle (MOTIVE) of M standing for Uterine Massage; O for Oxytocic Drugs (to promote uterine contraction); T for Tranexamic Acid (TXA) to reduce excessive bleeding; IV for Intravenous Fluids (to stabilise blood pressure); and E for Examination and Escalation of Care. 

At the moment, a cluster-randomised trial conducted in Kenya, Nigeria, South Africa, and Tanzania showed that implementing the E-MOTIVE approach reduced severe PPH cases by 60 per cent. 

Fadirah Tijani, a Nigerian mother, is one of the lives saved by this approach. “I almost died during my last delivery because of bleeding,” she recalls. “But the hospital staff quickly gave me an injection and IV fluids. I survived because they knew exactly what to do.”

What Must Be Done?

While the E-MOTIVE strategy is a game-changer, its success depends on widespread implementation. To effectively combat PPH and reduce maternal mortality, the following urgent steps must be taken to ‘Strengthening Healthcare Systems’ by equipping all primary healthcare centres with essential medications, including oxytocic drugs and tranexamic acid; improving blood transfusion services and establish functional blood banks in every state; and upgrading maternity wards in rural hospitals to provide emergency obstetric care.

Also, through ‘Training and Capacity Building’, provide regular training for healthcare workers on PPH management and the E-MOTIVE protocol; and integrate traditional birth attendants (TBAs) into the formal healthcare system by training them to identify and refer cases of PPH immediately.

Using ‘Community Engagement and Education’, there is need to launch community-based radio programmes and social media campaigns to raise awareness about the dangers of PPH; engage religious and traditional leaders to advocate for hospital deliveries and debunk myths surrounding medical interventions; and encourage male involvement in pregnancy and childbirth, ensuring that husbands support their wives in seeking proper medical care.

Importantly, through ‘Financial Support for Maternal Care’, subsidise maternal health services by reducing or eliminating user fees for maternity care; and expand health insurance coverage to ensure low-income women can access hospital-based deliveries.

A Call to Action: No More Needless Deaths

Postpartum haemorrhage is not an unsolvable problem—it is a tragedy of neglect. The knowledge, tools, and resources exist to prevent these needless deaths, yet too many Nigerian women continue to die because of a lack of political will and systemic failures.

If Nigeria is serious about achieving Sustainable Development Goal (SDG) 3—ensuring healthy lives and promoting well-being for all—it must prioritise maternal health. The time for rhetoric is over. It is time for action.

Every mother’s life matters. No woman should die bringing life into the world. The question is, will Nigeria act fast before more mothers are lost?