Post-intervention outcomes 4 years after a nationwide postpartum haemorrhage mortality reduction project in Niger’s health facilities: a retrospective analysis

OBJECTIVES: Niger in West Africa reduced maternal mortality by 34.5% among 1 380 799 health-facility births over 72 months through 2020 by more than halving postpartum haemorrhage (PPH) mortality in health facilities nationwide, using low-cost obstetrics technologies and 11 public health disease-eradication tools. Monthly support ended in December 2020 because of a lack of funding. Sustainability of innovations is important, given declining external funding and expectations that even very poor countries fund health from domestic taxes. Therefore, the current study assessed for PPH mortality rebound, also because 2015-20 results had been better than expected. METHODS: Routinely collected government maternal mortality data during the 2015-20 project period and the 2021-4 post-project period were tested using Poisson regression models, and the Cochran-Armitage test for trend. RESULTS: Among 2 158 021 health-facility births from 2021 to 2024, no significant change was seen in the proportion of maternal deaths caused by PPH, PPH case fatality, PPH cases per 100 000 births, or PPH deaths/1000 births compared with the preceding 4 years. CONCLUSIONS: Niger's >50% PPH mortality reduction was sustained for 4 years without external attention to its implementation. Given sustained success emanating from capacity-strengthening, the strategy should be tested in other settings where maternal mortality remains high.