India
oi-Oneindia Staff
A new Lancet Series (June 12, 2026) and the proven E-MOTIVE strategy offer India a practical, low-cost pathway to dramatically cut postpartum haemorrhage (PPH) (which causes nearly one in three maternal deaths in many parts of the country) through early detection and bundled care.
A Lancet Series (June 12, 2026) details the E-MOTIVE strategy, providing India a low-cost approach to significantly decrease postpartum haemorrhage (PPH) mortality via early objective blood loss quantification and bundled care.
Postpartum haemorrhage or simply put, excessive bleeding after childbirth, remains one of the gravest threats to Indian mothers. A Lancet study published as a three-part series on PPH has some shocking statistics to share.
On June 12, 2026, The Lancet (https://www.thelancet.com/series-do/postpartum-haemorrhage) published a landmark three-paper Series on PPH, led by Professor Arri Coomarasamy of the University of Oxford (with key contributions from HRP/WHO and international collaborators).
It builds on the 2023 E-MOTIVE trial (https://www.ox.ac.uk/news/2026-06-11-new-lancet-series-shows-how-thousands-of-maternal-deaths-could-be-prevented-each) and emphasises prevention, objective early detection, and swift standardised treatment as achievable goals that could transform outcomes globally, and especially in high-burden countries like India.
Across India, PPH accounts for approximately 19.9-38% of (or 2 to 4 out of every ten of) maternal deaths depending on the region. Shockingly, in regions with higher burdens of maternal deaths in childbirth for example in areas like Northeast India and parts of Delhi it can exceed half of haemorrhage-related fatalities.
Incidence ranges from 2-4% in vaginal deliveries to about 6% in caesareans. A paper (https://www.pib.gov.in/PressReleasePage.aspx?PRID=2113800®=48&lang=2) published by the government shows that while India has made impressive progress, reducing the maternal mortality ratio (MMR) to around 97 per 100,000 live births (2018-20 data, with further declines noted), PPH continues to claim thousands of lives annually, particularly among women with anaemia, those delivering at home or in under-resourced facilities, and during emergency caesareans.
The Game-Changer: Objective Measurement + E-MOTIVE Bundle
The authors also challenge one of maternity care’s most entrenched practices: visually estimating blood loss after birth. The Series concludes that this approach is grossly inaccurate, missing around half of all PPH cases.
Instead, it calls for routine use of simple objective measurement tools, such as calibrated blood collection drapes, which can detect excessive bleeding far more accurately and trigger life-saving treatment sooner.
Across India as well, estimation of blood loss has been a more prevalent method of hospital staff to record the seriousness of haemorrhage in new mothers after childbirth.
Truly enough, as pointed out by the Oxford and Lancet papers, this method is not only notoriously inaccurate, it also imperils the lives of the new mothers and thereby of the new-borns by often underestimating by 20-41%.
This leads to delayed diagnosis in up to half of cases, says a WHO report. The solution is strikingly simple: a low-cost, calibrated blood collection drape, an inexpensive plastic sheet with a graduated pouch that hangs off the delivery table and precisely measures blood loss.
This device enables early detection: treat as PPH if blood loss reaches 300 ml with abnormal vital signs, or 500 ml regardless.
Once PPH is detected, the E-MOTIVE bundle kicks in immediately (not sequentially):
Early detection (with the drape)
Massage of the uterus
Oxytocic drugs (e.g., oxytocin)
Tranexamic acid (TXA)
IV fluids
Examination of the genital tract and escalation
In the E-MOTIVE cluster-randomised trial (over 210,000 women in secondary hospitals in Kenya, Nigeria, South Africa, and Tanzania), this approach reduced the composite outcome of severe PPH (≥1000 ml), laparotomy for bleeding, or maternal death by 60% (1.6% vs 4.3%).
PPH detection nearly doubled (93% vs 51%), bundle adherence soared (91% vs 19%), and blood transfusions for PPH dropped. Maternal deaths from PPH were lower, though the trial was not powered primarily for mortality.
India context: Many Indian studies echo these challenges, visual estimation errors, delayed bundle implementation, and fragmented care.
A 2023 summary in the National Medical Journal of India by Rai and Bhatla (AIIMS New Delhi) highlighted the E-MOTIVE trial’s relevance for LMICs like India, where calibrated drapes are rarely used and TXA is not universally available at secondary levels. Substandard care, staffing shortages, and home births amplify risks.
Prevalent practices in India:
Deepti Sharma Professor & Head, Obstetrics & Gynaecology Amrita Hospital, Faridabad told One India that even experienced obstetricians may have a hard time accurately estimating blood loss by eye alone.
“Amrita Hospital is dedicated to the goal of objective quantification of blood loss rather than just visual estimation,” Dr Sharma says. She added that if calibrated blood collection drapes are not available in some remotely located maternity hospitals, it would be advisable to quantify the volume of blood collected and weigh the blood-soaked swabs and pads.
“Monitor maternal vital signs and uterine tone continuously. Objective measurement allows earlier identification of excessive bleeding and treatment to be initiated before the patient becomes haemodynamically unstable. The principle is backed by the E-MOTIVE approach. Postpartum haemorrhage can develop in minutes, so early detection is the first step to saving lives,” Professor Sharma of Amrita Hospital added.
The Importance of having PPH Emergency Kits in the Labour Room:
“Preparedness, not reaction, is the key to successful management of postpartum haemorrhage.
Every labour ward should have a standard emergency postpartum haemorrhage kit containing uterotonic drugs (oxytocin, tranexamic acid), intravenous fluids, large-bore cannulas, blood collection supplies, emergency instruments and clear treatment protocols. It is designed to avoid delays in locating medicines or equipment in an emergency, Dr Sharma advises.
“Obstetric haemorrhage is not like any other haemorrhage. A woman can bleed out her entire circulating blood volume in a matter of minutes. Thus resuscitation and diagnosis and correction should be simultaneous rather than sequential. Prompt recognition, effective treatment and a co-ordinated multi-disciplinary team approach are the cornerstones of management of this obstetric emergency,” Dr Sharma warns.
In a well prepared obstetric unit these interventions should be commenced within minutes of the recognition of postpartum haemorrhage. That is why Dr Deepti Sharma suggests a protocol including regular simulation drills and defined roles that enables all members of the team (obstetricians, anaesthetists, nurses, blood bank staff and support staff) to respond quickly and effectively.
Why This Matters Urgently for India
High volume: India contributes significantly to the global 27 million PPH cases and ~43,000 deaths yearly.
Equity gap: Rural, anaemic, and poorer women suffer most. Home births and under-equipped facilities see higher fatality rates.
Economic toll: Globally $10.4 billion; in India, the human and health-system costs are enormous, including hysterectomies, long-term morbidity, and impacts on surviving children.
Feasibility: The drape is inexpensive and the bundle uses existing drugs and skills. Implementation strategies (training, local champions, PPH trolleys, audits) proved effective in the trial.
The Lancet Series stresses addressing modifiable risks (anaemia, unnecessary caesareans), uterotonic prophylaxis, and avoiding delays in the “race against time” from diagnosis to definitive care.
Implementation Roadmap for India
States and facilities can integrate calibrated drapes into labour rooms, update protocols to trigger the full bundle early, ensure TXA availability, and train midwives and obstetricians together. Audits and quality improvement, already part of many LaQshya and other initiatives, can drive adherence. Scaling this in secondary and district hospitals, where most deliveries occur, could accelerate MMR decline toward the SDG target of 70.
The largest burden of maternal deaths due to postpartum haemorrhage occurs in resource-limited settings where access to emergency obstetric care may be delayed. Smaller hospitals often suffer from lack of trained personnel, lack of blood transfusion facilities, and lack of emergency medications, delay in referrals and lack of standardized treatment protocols. The risk is even greater when there are delays in transportation, particularly when women deteriorate rapidly.
Dr Sharma suggests upscaling simulation-based training, ensuring 24/7 availability of essential medicines, introducing calibrated blood-loss measurement tools and strengthening referral networks between primary health centres and tertiary hospitals. She feels this step can go a long way in reducing maternal mortality across India.
“All health facilities that deliver babies should not only have medicines available but should also have a team that is trained to identify and manage postpartum haemorrhage at its earliest stage. The E-MOTIVE approach is an important step to standardise emergency obstetric care and ensure that all mothers receive timely evidence-based treatment regardless of where they deliver,” Dr Sharma advises.
This is exactly what the Lancet-Oxford University study suggested. Professor Coomarasamy and colleagues note that the knowledge and tools exist, the challenge is consistent implementation. For India, already a leader in scaling maternal health interventions, adopting E-MOTIVE offers a high-impact, cost-effective way to save thousands of mothers’ lives in the coming years.
