E-MOTIVE: How a Gates-backed Intervention is Chipping Away at Nigeria’s Maternal Death Crisis

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 minutes, faster than Kenya (17 minutes) and South Africa (30 minutes) and across all four countries, 96–100 per cent of haemorrhage cases were diagnosed within an hour of delivery.

From Trial to National Rollout

Following the trial results, Nigeria, through Kano and Bayero University’s African Center of Excellence for Population Health and Policy at Aminu Kano Teaching Hospital, became one of the implementation sites for scaling E-MOTIVE into routine care, under the Accelerating the Expanded Adoption of RMNCH Innovations and Health Reforms (AEARI) project. 

It’s run by West and Central Africa Health Options (WCAHEALTH), supported by Technical Advice Connect (TAConnect), and funded by the Gates Foundation, spanning March 2024 to June 2026.

Kano was a deliberate target as the state is described by health officials as having the country’s highest number of maternal deaths by population, concentrated in roughly 18 of its local government areas.

Recent reported results from that Kano rollout, presented at a WCAHEALTH stakeholders’ workshop and separately at the project’s learning and dissemination meeting where 

Kano State Commissioner for Health, Dr. Abubakar Labaran, said the state’s maternal mortality figure fell by about 50 cent, from 1,206 to 570 recorded cases, attributing the improvement to E-MOTIVE and the calibrated drape.

A separate WCAHEALTH presentation cited a decline from roughly 1,025 to about 937 per 100,000 live births.

In the target local government areas, WCAHEALTH’s Dr. Ofuoma Omo-Obi said 14,000 babies were delivered with zero maternal deaths; about 4,500 women received calibrated treatment drugs; and 507 women who developed postpartum haemorrhage were successfully treated, cases she said would very likely have been deaths before the programme.

The state government has procured 484 ambulances for its 484 primary healthcare centres to speed emergency transport for women in labour, and expanded free maternal healthcare commodities across those facilities.

Kano’s health commissioner said the state is targeting a further 25–30 per cent  reduction over the next 18 months, with an eventual goal of zero maternal mortality within three to four years — a directive attributed to Governor Abba Kabir-Yusuf.

The national picture beyond Kano

Nigeria’s federal government has been pairing facility-level interventions like E-MOTIVE with broader system investments. 

In May 2026, Coordinating Minister of Health and Social Welfare Prof. Ali Pate’s ministry launched the Nigeria Strategic Direction for Midwifery 2025–2030, aimed at expanding the skilled-birth-attendant workforce nationally, one of the structural gaps (57 per cent of births still lack a skilled attendant) that PPH-focused interventions alone can’t fix.

The Gates Foundation has also framed E-MOTIVE as part of a wider regional push, a similar rollout in Kenya’s Makueni County, using the same calibrated drape and bundle, has been folded into that country’s national maternal care guidelines. 

Federal and Gates Foundation officials meeting in Abuja in late 2025, under the Regional Think Tank on Accelerating Implementation for Maternal, Newborn, and Child Nutrition and Health (AIM MNCH), pointed to Kano’s reported drop in maternal deaths, cited there as falling from “over 1,000 to about 500” per 100,000 live births, as a model they want replicated in other states and countries.

Nigeria’s maternal mortality ratio last had a solid nationwide benchmark in the 2018 Nigeria Demographic and Health Survey, which put it at 512 per 100,000 live births nationally, already far above the global figures cited above, which reflect more recent WHO/UNICEF/UNFPA/World Bank modelled estimates (1,047 per 100,000).

 A fresh, nationally representative maternal mortality figure from the 2023–24 NDHS specifically for maternal deaths (as opposed to under-five mortality, which that survey shows falling from 132 to 102 per 1,000 live births). That gap matters: the state-level figures coming out of Kano are encouraging, but more definitely needs to be done. 

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Nigeria carries the heaviest maternal death burden of any country on earth, accounting for about 28–29 per cent of maternal deaths recorded worldwide…

The E-MOTIVE intervention produced a 60 per cent reduction in severe postpartum haemorrhage and its associated adverse outcomes