Maternal Mortality is Solvable

expert in safe pregnancies and healthy deliveries around the world. Now, if you had to guess how many babies would you say are born every day, I'll give you a second. Now I cheated. I looked it up and UNISF estimates that an average of wait for it, three hundred and fifty three thousand babies are born each day around the world. Is not incredible. It's more than four births every second, and most of those they're safe for both the mother and the baby. But many of those births are not.

In fact, nearly eight hundred and thirty women die every day due to complications during pregnancy and childbirth. Now, most of these deaths can be prevented through skilled care at childbirth and just having access to emergency obstretric care. But in Sub Saharan Africa, where maternal mortality ratios are the highest, fewer than half of women are attended to by a trained midwife or a nurse or a doctor during childbirth. So you can probably guess that maternal deaths mirror the

gap between the rich and the poor. Less than one percent of maternal deaths happen in wealthy countries. But I wonder if you knew that America has the highest maternal mortality rate of all industrial countries, in fact, by several times over. Maternal and tile survival are the hallmarks of

healthy communities, and doctor Rown knows that. But he also understands that although major advances in digital technology and data science are definitely improving health intervention effectiveness, the global health divide persists. All of these wonderful innovations, well, they're just

not reaching the poorest and most vulnerable communities. Doctor Rao envisions a world where the data gap, and therefore the health gap, can be bridged, and we'll hear more about how he reached this thinking and also his daily work towards this much better future. Let's listen to him now with an apple bound What in your background led you to this problem? How did you identify this as a

concrete problem that can be solved? And how must have been about twenty five part of my training as a medical student in rural India, and I remember this sixteen year old girl being brought in. She had twins, and these were the days when we didn't know she had twins. There was no echo cardiogram, and apparently she delivered one of the twins at home. It was a prolonged labor. And now they brought her in to the hospital because

she had a second baby that was also obstructed. And I remember there and helping with that, and as part of that second delivery, she started bleeding and then literally bled out, and I remember trying to stem the blood and it's so horrific when you see blood gushing out of a woman's Wigiane's just and you could see that she was dying, and she knew she was dying. But I never forget that, but that stayed with me. And

that was almost forty five years ago. And when I got to America and I finished my training and was a practicing physician, I was horrified to hear that this problem still exists and in fact is getting worse in some countries, and that even today woman died during pregnancy and childbirth. The tragedy is that we know how to save them. Most of the drugs and most of the procedures have been in place since the nineteen forties, and in some countries there is no materal mortality so to

speak of, and so it is solvable. It has been solved in this day and age. There's some Scandinavian countries that have solved it. So it is truly solvable, and it has been solved. The fact that we still have eight hundred women dying every day. Literally that's two jumber jets crashing every day. I realized that we as a human race are not going to progress unless we say no to these unnecessary debts. Walk me through the nature

of the problem. So you say, the medical profession has come up with solutions, we have ways to prevent women from dying in childbirth. What is stopping people from getting the healthcare that they need. I'll break it down. It's very traditionally broken down into three segments. They're called three delays. And this is very well researched and written about The

first delay is delay in seeking care. So this is a delay in the woman herself going to the hospital getting prenatal checkups, understanding that this needs and should be a medical care and take care of her body and her health, or the family also understanding that this should be a delivery in the facility and that usually the feeling in these villagers is the mother in law saying, look, I delivered your husband in that back room. You go

and do it. We're not going to spend money on hospitals doctors, and by the way, you still have to sweep the barn and make the cows. So the first delay is in seeking care even is a huge delay. And the second delay is getting to care. So they have realized, okay, they have done that, they've gone and seen and had some prenatal checkups, but they have not

planned for how they're going to get to care. Either they have not don't have the money at the last minute to pay for the automobile the taxi, or they're no ambulances, or even in certain parts such as Zambia, if the flash floods have come and the road is washed out, there's no way to get to care. So the second delay is in getting to care. And the

third delay is receiving care. So there sometimes they do that and they come and at the hospital there is either no alexity, there's no medication, there's no train doctor, there's no anesthesia, there no facilities, And so the third delay isn't receiving care. And so it's not just enough for us to say, oh, okay, we'll make sure they're ambulances, because if they don't get into the ambulance, it's meaningless.

And or if they say, we say, we'll just put dication and we'll train doctors, but if you haven't done the community outreach to make them want to come, it's meaningless. So really all three delays need to be addressed together. And usually most of these women die a combination of

the delays. Most often it's all three. So maybe can you give me some idea of what we're talking about in terms of numbers how many women die annually, but also how have those numbers been reduced in recent years, and how do you foresee them being reduced further in the next ten or twenty or thirty years. The goal is to reach preventable maternal mortality, to reduce it down

to seventy by twenty thirty. I mean, no death is acceptable, but seventy is a number that the world has put us taken the ground saying, if we can make sure every country comes down to seventy, that would be achievable. Some countries today that number is five and in some countries that number five thousand, and so we have made huge progress in the last ten years. We've halfd metal mortality as a world, but we're still very far away

from the seventy number. And the business is usual as the rates of reduction as we see it now will not get us to that number of seventy metal mortality. So there has been a huge progress, but the rate of reduction is not enough to get us where we want to go. Those are the numbers. And currently, as I said, eight hundred women die every day in the world, and by the way, seven hundred women die every year here in the US. It's almost two deaths a day. Wow.

So how do you overcome this first barrier? How do you convince people to come to appointments, to come to hospitals. How do you get them used to the idea that birth is not something that takes place at home. So

if you take India as an example. They have done a huge outreach to including conditional cash transfers to community health workers to bring these pregnant women into the facilities, and there was a push and there's almost been an eighty percent increase in facility birth rates in India, so it can be done, and behavioral change communications they've been they've used local storytelling, they've used the power of pure experience, so all that has worked, and in fact there's been

a huge increase in facility births rather than birthing at home. But unfortunately that eighty percent increase in facility births has not resulted in an equalent eighty percent decrease in maternal mortality. The facilities were not ready for this onslaught and the quality of care they were receiving or the protocols that they had in place were not suffice and so they

did initially see the eighty percent decrease. But the way India went about it is first is raising the demand, using the awareness and incentivizing women to give birth in facilities, including making the whole experience free, including the transportation, and now are very much focused on the quality that the

woman will receive during that childbirth process. If you add to that data analysis and data predictability and predictive analytics to see which woman is a high risk and once they come into the hospital and to triage them, and to be able to use the latest and the best in data and technology is again leads us to believe this is solvable and hence is something we should be doing. Tell me a little bit more about data. You know, we're talking about remote communities. What kind of difference can

data make? How does that help doctors in rural India. I have been in communities and it's amazing how the advent of mobile phone technology has so penetrated even the

rural areas in a lighter way. They say, they probably more telephones than bathrooms in India, and so the people who have access to a phone more easier than electricity with that kind of penetration, I have seen, say in that village, in these communities, in a house, the husband who's usually the farmer, the male, the man has a phone and today on his phone, the farmer has a weather forecasting app that tells him went to plant and

went to harvest. He's got an app that tells him the prices of his harvest and the produce in the market that day, so he knows when to sell. He also has on an app transportation like the equordent of the ubers, to be able to move his produce and his harvest to the cities for a better price. This

exists today, We've seen it. And in that same house is the wife who's the community health worker, and she carries around six registers, does not have access to the phone, has twenty families that she's seeing, has no idea how to optimize her day, which household is at risk, which child in her community of who she's responsible is at risk for my nutrition? Why couldn't she have similar predictive analytic tools like weather forecasting that would help her do

her job better. So it is not just the doctors having access to data, It is how can the community health workers, the frontline healthcare workers have predictive analytics tools that will optimize their work process but also in real time can give them insights and inputs on how to take care of these patients, of what tests to do, which ones are the triage, which ones are the ones

at high risk. So this could be something as simple as community health workers having a kind of app on their phone that could help them give advice to pregnant women or help them make decisions about who needs what kind of care. That would be exactly the start. From there, you can envision where she could have the story of her village to know if there's a huge absence of children in one school in her community, she should now go there to see is there a diary outbreak, what's happening?

Why are the children are coming to school? There are so many ways we can then build on it. What about doctors in these communities, how can they access data and how can that make a difference to what they do?

So take supply chain. Most doctors in these villages, if there's a primary secondary health center, the doctor in charge is the superintendent of the hospital, and he or she has never been trained on stock forecasting, has never been trained on human resource distribution and how to supply and demand.

If these apps can actually in real time keep track of stockouts demands, is there any way that the data can give a better insight to these doctors to be able to do a better supply management, better access to where the crisis and they can they have an access that tells them based on social media and other data inputs. Where are the migrants coming from, what's happening across borders, where is the water on area, what's happening, is there

another ebola brewing? Data can help identify hot spots and cold spots. Cold spots could be a whole region where children have not being immunized and nobody's kept tracked and we don't know because they are in the blind spots. Hot spots could be where this flash pandemics or something brewing that we could get earlier warning. But what about

specifically to deal with the issue of maternal mortality. Is there you know, are there particular kinds of programs or apps, or is there a kind of data that doctors can

find particularly useful. So if the frontline healthcare worker can find out if there is a region where women are not coming to anti natal care for visits and could be very easily tracked based on whether the woman has made an anti natal visit and if she asn't, they could even make home visits or they could encourage the woman to come in and we know, for example, simple antenatal visit to check for protein in the urine, blood pressure, sugar levels make a huge difference. I've also seen an

app it's in formulation stage. It's actually the camera can take a video. So I've seen where in India, the healthcare worker waves this camera her cell phone over the belly of the pregnant woman. An inside, there is an algorithm that based on that image and that picture that's taken, the woman's size of the pelvis is measured, and the baby's head is measured, and an algorithm predicts whether this will be an obstructed labor, whether the child's head is

too big for the woman's pelvis. Wow, And that can be put in a cell phone. Yes, I've seen it. It already exists. Inside obviously has to be finalized and commercialized, but people are thinking that way. So if you think about how data and applications are changing in our lives today, there's so many people with the Apple Watch that has

the health monitor on it. What can we do if we take that kind of mindset and those kind of assets to the developing world to improve public health, community health And to me, I'm using maternal mortality as a sentinel indicator the Canadian the coal mine, so to speak, where it tells me the status and the health of the community, because the first ones to die, the most vulnerable, are the pregnant woman, and if we can save them, it means very likely we have a system in place

that is saving many people. And so these data, these tools are needed, are needed today. They exist. Is just that somebody has to put it together, and that's where we are. Do you get any opposition to the use of technology and data? Do you find that people distrusted? Do you have people rejecting it? In the countries that I am working on right now, I can presume it will happen. India is putting in place draconian and much needed and many aspects health data, privacy and security laws.

So it is coming. But right now, when we show up and we talk about how we are helping women survive childbirth, there is open arms and even in even in communities. Here in the US, it's the only developed country in the world where metal mortality is rising. And that is really an absolute shame, considering that we spend more than any other country on healthcare. And is that is that for similar reasons you have these same kinds

of obstacles in the US that you have here. Yes, they are the same three delays, but they have a different connotation. So the second delay is not that there's a flash fard and they can't get to The second delays she's in a housing project and taxis won't come there. She doesn't have money for a taxi, and she can see the hospital, but she can't cross it because there's a huge highway in between. So, yes, you can envision the delays. The concepts are the same, the details are different.

Also here in this country we have slightly different causes. In the developing world. That three big causes are woman bleeding, which is postpartum hemorrhage, pre acclamps here, which is when the blood pressure shoots up and you get seizures and brain damage. The third is sepsis, which is infection. Here in the US it is coiegulation disorders, it is how do you askular disease, It's comordabilities, it's older woman, it's obesity. It's also general lack of health and women not engaging

with the healthcare system. So there are similarities, there are some nuance differences, but the bottom line is the same. Women are dying from preventable causes, and to think that the rate is going up in this country is just unacceptable. I agree, it's very shocking. It's all very well talking about technology and apps and cell phones, but how can you use this technology parts of the world where power is unreliable and internet connections are unreliable? Do you have

solutions for that as well? So any and all attempts at improving health will also have to buy nature address the data inequity gap. Yes, electricity, internet connectivity, all these are current barriers, but these have been bridged. There are solutions for this. They are off grade solutions. They are

offline solutions. And in fact, most of the apps that exist in most of the ones that are working right now in parts of Africa by large part work offline and then when the internet connection is there, they do the upgrading. So these are solvable by technology. But it's that feeling that we can and should do it that is the piece that we need to cross. And once we've crossed that, I have a feeling we can get

to all these current barriers. Even if you would have asked me twenty years ago if I was in charge of all health for a coastal village that was that was routinely hit by hurricanes, and they asked me, what would I have to do to make to save people when the hurricane comes. Based on what I knew then, I would have said, Oh, we need to build more shelters, we need to have more hospitals, we need to have more collar of vaccines, we need to have more clean water.

How do I save the lives? Based on what I know? But today probably the thing that saves more lives is the weather predicting app forecast that tells me the storm is coming and I can evacuate people. And I would have never thought of that as saving more lives. Twenty five years ago, I'd have built more hospitals, more shelters, But today that single app is saving more lives than all the things we could have done. Similarly, today, if we were talking about how can we save these mothers

from dying, we're talking about internet connect community. We're talking about more hospitals, better training, on and on and on. Perhaps there's technology out there that will take us to

a completely different place. I just want to make sure that the current barriers don't hold us back, and that we do understand there's a data in equity and that that is exacerbating health in equities, and what are the obstacles to you, what's still standing in your way, what's keeping you from bringing down the this mortality rate more quickly? So I will I will start that by quoting doctor Mohammad Mahmata was an obstitation is an obstacian who considered

the father of this whole concept. He very famously once said, and I'm quoting him, women are dying not because we don't know how to save them. They're dying because we have yet to decide their worth saving and to live. That it is very clear that for any of what solutions we come up with to stick, sustain and scale in country, first we need the country. We need a political sustainability. We need political will. We need the policymakers,

the decision makers to decide that the woman are worth saving. Second, we need social sustainability. We need the culture to be where the woman is valued and where healthcare is considered important for these women to get and to deliver in

a facility. And then we also need the commercials sustainability that whatever systems are put in place have to benefit society and that we do understand that these are not just programs that we can go in and set up as philanthropy and turn around and walk away, because we need to teach them out of fish, and then we need to make it commercially viable for them to fish rather than just give them the fish. So we need to set up systems where this is then sustained locally

within the community. So that is the barrier is how do we sustain scale the solutions that we put in place. But it also sounds like, you know, there are these incredible pieces of technology available, but there's also a fundamental emotional or psychological obstacle, which is that not everywhere do people think that women's lives are important. Obviously that is

true here in the US too. They are countries that have come together that have realized that saving the woman is not just that I think to do, but it's the smart thing to do. And there is equality and there is no mental immortality so to speak of. So it is just this that they are still communities and their countries that wage political wars on women's bodies, and even here in this country is no different. So we need to be able to break those barriers. But just

breaking those barriers and not enough. We need to come up with the medication technology training to then actually really save them, because no amount of cultural training will help the woman who needs associated section. A lot of people listening to this might be inspired by some of the things you've said and might like to want to try and help solve this problem. Are there things that listeners can do? Do you have any advice for people listening?

So the first thing, there are many organizations that are linked. I would say, be aware, get to know it, and if you depending on the sliding scale, whether you suggest your pocket, whether you can give some money, whether you can give time, whether you can give some volunteer hours work, it's a sliding scale. I think it all depends on where your heart is. But I think the journey should start from educating oneself, finding out who are in this space,

and then reaching out. And obviously, the Rockefeller Foundation has our website, and on that website there's a health section, and then you can see how we are working towards trying to solve this. Really powerful words from doctor Navine Rao from the Rockefeller Foundation there about maternal mortality and also talking about what it's really dealing with, which is women and children's lives, and how things can change when

society decides that they are worth saving. Solvable is a collaboration between Pushkin Industries and the Rockefella Foundation, with production by Laura Hyde, Hester Kant, Laura Sheeter, and Ruth Barnes from Chalk and Blade. Pushkin's executive producer is Neia LaBelle, Research by Sheer, Vincent, engineering by Jason Gambrel and the great folks at GSI Studios. Original music composed by Pascal Wise and special thanks to Maggie Taylor, Heather Fine, Julia Barton,

Carly Mgliori, Jacob Weisberg, and Malcolm Gladwell. You can learn more about solving today's biggest problems at Rockefella Foundation dot org, slash Solvable. I'm Mave Higgins now got solvus then