Kenya Urged to Rapidly Adopt WHO’s E-MOTIVE to Combat Postpartum Hemorrhage

By Samwel Doe Ouma

When a woman dies giving life, it is tragically often from a cause both preventable and treatable, such as postpartum hemorrhage (PPH), an expert highlighted.

The Health NGOs Network (Hennet) emphasizes the critical need for sustained attention and accelerated action to ensure no woman succumbs to preventable causes during childbirth in Kenya.

Hennet says that Women in Kenya continue to face significant challenges during pregnancy and childbirth, including limited access to high-quality healthcare, financial constraints, and insufficient access to quality maternal medicines.

In Kenya, where approximately 6,000 women tragically die from maternal causes each year, the Ministry of Health, in collaboration with partners like Jhpiego, is now confronting PPH with a potent global innovation: the World Health Organization’s (WHO) E-MOTIVE bundle. This life-saving solution is poised to dramatically reduce severe bleeding after childbirth.

JimKelly Mugambi, a Technical Officer with Jhpiego, presented compelling data during a recent webinar hosted by Hennet, titled ‘Implications of the SHA on Maternal, Neonatal, and Child Health: The Voice of the Community.’ said that current maternal mortality ratio stands at 355 deaths per 100,000 live births in Kenya.

“Postpartum hemorrhage remains the leading direct cause of these deaths,” he stated, underscoring the urgent need for widespread adoption of lifesaving interventions such as the E-MOTIVE solution.

Mugambi urged for the rapid embrace of this new approach, highlighting its potential for a major breakthrough in curbing deaths from childbirth-related bleeding.

Globally, PPH accounts for over 90percent of maternal deaths in low- and lower-middle-income countries.

Defined as the loss of more than 500 mL of blood within 24 hours after birth, PPH affects an estimated 14 million women annually and causes around 70,000 deaths—equivalent to one death every six minutes, predominantly in low and middle-income countries.

In Kenya, between 2015 and 2018, 38 percent of maternal deaths were attributed to obstetric hemorrhage, further emphasizing the scale of this crisis.

The tide is beginning to turn, thanks to the E-MOTIVE bundle—a structured and timely package of interventions designed for early detection and rapid management of severe bleeding after childbirth known as postpartum hemorrhage.

“Traditionally, diagnosis of PPH relied on visual estimation of blood loss—a practice prone to error and delays,” Mugambi explained. “We now know that calibrated drapes, which collect and measure blood loss in real time, offer a much more accurate assessment.”

The E-MOTIVE approach introduces a critical monitoring chart where healthcare providers record bleeding, blood flow, and uterine tone every 15 minutes in the first hour after birth. Blood pressure and pulse are tracked with equal frequency. Trigger points for initiating the bundle include clinical judgment, blood loss of 500ml or more, or 300ml accompanied by abnormal vital signs.

This early detection method is vital. “What we are doing now allows providers to identify dangerous bleeding before it’s too late,” said Mugambi. “We’re no longer waiting until a woman is in shock.”

Once postpartum hemorrhage is diagnosed, the E-MOTIVE bundle is initiated—ideally within 15 minutes. It comprises five coordinated interventions: uterine massage, administration of oxytocic drugs, tranexamic acid (TXA), intravenous fluids, and examination of the genital tract and placenta.

Crucially, the new approach insists on immediate, simultaneous application of all bundle components. “Even if bleeding slows after the first step, we continue. It’s all or nothing,” Mugambi emphasized. Tranexamic acid, previously administered only after other methods failed, is now given right away—within three hours of birth. Significantly, Kenya has signed clinical protocols that empower midwives to administer TXA without waiting for a doctor’s prescription.

“This is a huge step,” said Mugambi. “It reduces delays and saves lives.”

The implementation of the E-MOTIVE approach not only standardizes care but also fosters synergy among health providers. “Teamwork is key,” Mugambi noted, highlighting how providers are now working in unison, with clear roles, and utilizing crash carts stocked with all necessary supplies.

Healthcare workers have reported improved confidence, especially when using calibrated obstetric drapes. These tools facilitate rapid decision-making, better documentation, and a unified understanding of what constitutes excessive bleeding.

“Early detection and timely intervention mean fewer women are dying. We are seeing significant reductions in severe PPH cases, blood transfusions, surgeries, and maternal deaths,” Mugambi affirmed.

Despite these advancements, persistent challenges remain, particularly regarding the quality of medicines. A 2020 systematic review found that a concerning 75.4percent of ergometrine, 39.7percent of oxytocin, and 38.7percent of misoprostol samples in low- and lower-middle-income countries failed quality tests.

In Kenya, a 2022 study revealed that only 6 out of 17 oxytocin products met adequate pharmaceutical standards. This raises serious concerns about medicine regulation, supply chain integrity, and the capacity of health facilities to correctly store and administer these vital drugs.

“The issue isn’t just what drugs we have, but whether they work as they should,” Mugambi warned.

To address these systemic issues, Kenya’s Ministry of Health is now prioritizing Health Products and Technologies (HPTs) for PPH within its national strategic reproductive health documents. This includes incorporating heat-stable carbetocin for prevention and establishing protocols for self-administered misoprostol in remote areas lacking skilled birth attendants.

However, rolling out such innovations requires a collective, multi-sectoral effort.

“We all have a role,” Mugambi stressed. “From the Ministry to county governments, from private sector to academia and civil society—everyone must work together to ensure that life-saving products reach women wherever they give birth.”

The approach, he emphasized, is not merely about equipment or medication. It encompasses comprehensive training, consistent supervision, and behavior change at every level.

He added that facilities must reconfigure to ensure all PPH interventions are readily available at the point of care. Cleaning staff must be trained to properly disinfect reusable mats, and midwives must be empowered to act swiftly.

Kenya’s adoption of WHO’s E-MOTIVE bundle is more than a technical solution—it’s a profound moral commitment to protect mothers.

“Every maternal death is a tragedy that echoes across families and communities,” Mugambi concluded. “But the tools to prevent them are in our hands. We must use them—urgently, wisely, and together.”