The need for maternal care in the developing world

On a recent trip I took to India and Pakistan for Acumen Fund, I had the chance to visit LifeSpring Hospitals, which provides high-quality, low-cost maternal care. I wrote a blog post about this titled “Can a Hospital be a Breakthrough Innovation?” about my visit there on Mother’s day.

The more I’ve learned about the need for high-quality, low cost maternal care, the more I think that LifeSpring could be a blueprint for addressing an important, prevalent, but under-addressed health problem globally.

In India alone, only 43% of women are cared for by a skilled attendant during childbirth, and India’s 117,000 maternal deaths annually is the highest number in the world. The chances, over a lifetime, of an Indian woman dying due to complications in pregnancy and childbirth are 1 in 70. This makes an Indian woman 5 times more likely to die in childbirth than a Brazilian woman; 18 times as likely to die than a Chinese woman; 70 times as likely as an American woman; and 250 times as likely as a Swedish woman.

I don’t think I truly understood what poor access to maternal services means until I read this article from the Disease Control Priorities Project, which I learned about on Owen’s blog. Here’s an excerpt (be warned, it’s pretty graphic):

In developed countries, fistulas occasionally happen from surgical accidents or radiation therapy and are promptly repaired. Few in those countries have ever heard of the condition. But across much of the less developed world, fistula is an ordinary hazard of childbirth for many women and a permanent blight on countless lives. In those countries, obstetric fistula overwhelming results from obstructed labor, which occurs when the baby cannot pass through the mother’s birth canal because it either does not come head first or is too large for her pelvis. In the developed world, prompt medical intervention, often including Caesarean section, permits a delivery safe for both mother and child. But thousands of times each year in poor countries, birthing women receive no such aid and their labor is a futile agony lasting up to five days, with uterine contractions constantly forcing the baby, usually head first, against unyielding pelvic bone.

Long before the mother’s torment ends, however, the unremitting pressure kills the child. It also cuts off the blood supply to the soft tissues of her vagina and other organs trapped between the baby’s skull and her pelvis. Eventually these tissues also die, forming one or more fistulas, and the baby’s head softens sufficiently for the stillborn child to pass from her body. Should she survive, the mother soon finds urine, feces or both leaking unstoppably from her vagina. In about a fifth of cases, the woman also suffers nerve injury that can cause a condition called footdrop, which prevents normal walking. Constant contact with urine or feces irritates and infects her skin and other tissues. Her kidneys, bladder, or other nearby organs may also be damaged. Her menstrual periods may stop, rendering her infertile.

The article goes on to describe that, in addition to this physical and psychological damage, the mother often becomes a social outcast. It is stories like this that give me a real sense of urgency about the need to find, nurture and grow enterprises that are finding solutions and positioned to grow, and grow fast.