E-MOTIVE in 2026: Where are we now?

The EMOTIVE bundle approach was designed to improve the outcome of the management of PPH and reduce maternal mortality. The initial intervention was to ensure that the 20 high volume public hospitals could provide the EMOTIVE bundle approach for the management of PPH. During implementation of the EMOTIVE bundle approach calibrated drapes were used for 13,915 (61%) of the vaginal deliveries from which 726 (5%) were PPH cases, and all were managed using the PPH bundle, and no maternal death from PPH was detected. When we see the surgical management for the PPH cases 18 women were managed surgically during the implementation time compared to 252 during the baseline. This shows Use of calibrated drapes increases early identification and management of PPH which in turn reduces maternal morbidity and mortality due to PPH.

Background: Postpartum hemorrhage (PPH) is the second leading cause of maternal mortality in Malawi accounting for 20.4% of maternal deaths (2). Malawi's Ministry of Health introduced E MOTIVE PPH bundle an evidence-based approach (3) in 5 high burden districts. Methods: A taskforce was established to develop implementation road map, National reference manual and training materials. E MOTIVE principles were integrated into existing guidelines and protocols. Fifty percent of staff in selected facilities were trained, with remaining being mentored. Results: The implementation of the E MOTIVE PPH bundle has yielded significant improvements in postpartum care which has led to a 7% reduction of PPH cases from 2024 to 2025 and 16% maternal deaths from 2024 to 2025. Implications: The E MOTIVE bundle has improved postpartum care. Key takeaways include scaling up the bundle to additional facilities to reduce maternal morbidity and mortality. Teamwork is crucial in the management of PPH

FIGO's Leadership Development Initiative: Removing barriers to Effective Access and Coverage of maternal Healthcare (LDI:REACH) is a three-year program that drives quality improvement in maternal and newborn care through evidence based clinical interventions. The program partners with professional obstetrics and gynaecology (obgyn) societies and health facilities in Bangladesh, Ethiopia, India, Kenya, Nigeria, and Pakistan to identify and address system-level barriers using FIGO's Barrier Assessment Framework. The presentation will share learnings and outcomes from LDI:REACH, highlighting the role both obgyn professional societies and healthcare providers can play in leading improvements in quality care. Participants will be introduced to a practical framework to assess and take action to remove barriers to clinical best practice - tailored for low-resource settings. By the end of this session, attendees will understand how to apply this approach in their own contexts to strengthen provider leadership and increase the uptake of life-saving clinical interventions.

This presentation shares findings from a multicountry study assessing the quality of oxytocin and tranexamic acid (TXA) used in postpartum haemorrhage (PPH) treatment in low- and middle-income countries (LMICs). Laboratory analysis of products collected from the Democratic Republic of the Congo, Ghana, Kenya, Madagascar, Mali, Nigeria, Pakistan, Tanzania, and the United Kingdom revealed significant quality issues. Notably, 17% of TXA products did not meet international set standards, with some showing impurity levels as high as 84%. Importantly, compatibility testing showed that co-mixing oxytocin with non-quality-assured TXA can lead to substantial degradation of oxytocin, potentially compromising treatment efficacy. In contrast, heat-stable carbetocin (HSC) showed no such interaction. The results highlight the critical need to procure and use quality-assured maternal health medicines to ensure the safety and effectiveness of PPH interventions.