What if four Boeing 737s crashed every day?

Why our approach to solving maternal mortality needs to change.

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An Introduction to Maternal Mortality

Maternal mortality is any death within 42 days of pregnancy termination. “Pregnancy termination” could refer to aborting, miscarrying or giving birth.

Everyday >830 women die

830+ deaths/day

Annually, there are >300 000 deaths

300 000 deaths/year… also, HOLY SHIT.

If the world had the maternal healthcare system of Finland, there would be 98.6% fewer maternal deaths

Deaths if the world had the MMR of Finland
Deaths if the world had the MMR of the EU

This is a reduction we can make today.

Modern Day Hospital

99% of deaths are in the developing world.

Women in poor, rural communities sometimes give birth in huts.

This is what it looks like to give birth in the most dangerous hospitals:

Parts of the global healthcare system are trapped in the 1800s.

A farm in 19th century Sweden
Birthing teamwork

During this time, Sweden’s MMR was 830 deaths/ 100,000 live births

Today, there are places in the world that perform worse than Sweden 200 years ago.

Giving birth in rural Africa | Source
Giving birth in rural Africa | Source
Giving birth in rural Africa | Source

Sweden’s healthcare system was trapped in the 1800s because it *was* the 1800s. There was very little choice. But now it’s 2020 — countries shouldn’t be trapped in the 1800s.

Source

What are the causes of Maternal Mortality?

Medical Causes

The Basics of Pregnancy

Placenta (red), umbilical cord (red & blue cord)

Let’s talk about giving birth

Phases of labour | Source
Here’s a breakdown of the causes of Maternal Mortality | Data Source

Hemorrhaging

In Medical lingo, PPH is the loss of >500mL of blood within the first 24 hours after labour

There are 4 root causes of PPH.

Here’s the breakdown of PPH root causes | Data Source

Uterine Atony

The famous uterus 🤗

Trauma

Tissue Attachment

Thrombin

Hypertension

Unsafe Abortions

Nearly half of all abortions are unsafe in developing countries | Source

Infection

Systematic & Non-medical Causes

Structure of Maternal Healthcare

Source

Long story short: PHCs lack adequate staff and adequate equipment.

Example of PHC | Nasarawa, Nigeria
Single room four-bed space serving as male, female and children’s Ward at the Bosso PHC | Source
Umuokanne Health Centre | Source
The curtains are for privacy
Often, these foam beds are years old. They are soaked with former women’s body fluids.

3 Delay Model

Delay #1: Why do women not seek care?

A woman getting educated on maternal health. These are the type of interventions that help women seek care.

Delay #2: Why can’t women reach care?

Not to mention, the quality of general hospitals differs DRAMATICALLY. This is a general hospital in Vermont.
Road in rural Jigawa (80-90% of the population lives in rural areas). If it rains, roads will generally be blocked/inaccessible.
Compared to a maintained road in rural Vermont.

Delay #3: Why is care inadequate?

TBA helping give birth in a birthing hut.

It’s the poorest that are dying the most.

Money is the prime cause of death

Something is wrong.

A Deeper Take on Postpartum Hemorrhages.

PPH

Why are women dying?

Blood mat

What solutions exist for PPH?

Manual Removal of Placenta (Source)
Source
Source & Research Paper
Uterine Butterfly

What are their downfalls?

We can start solving this: there’s a gap in scaling Misoprostol & raising PPH awareness

Misoprostol

And, the pill is cheap to manufacture (just a matter of cents), does not require trained staff (it’s an oral pill), and can be stored at room temperature.

Awareness

Key Takeaways

Let’s build a world where pregnancy isn’t a death sentence.

Daughters get married off, so it is common for 15-year-olds to get pregnant| Source
<20% of Nigeria’s health centers are functional
“This is the place where she delivered before” (Giving birth in Ethiopia) | Source
Girls are more likely to die during childbirth in South Sudan than they are to complete secondary education.
Women laying on the floor in labour because of a lack of beds | Source
Hemorrhaging after birth| Source
1 in 8 women in Sierra Leone will die during childbirth, compared to 1 in 4000 in other countries | Source
Transport conditions are rarely sufficient
Nearly every family here loses one child before the age of five, usually through dehydration. They have five, six children and no time or money to take care of them” The world’s busiest maternity ward (Manilla) | Source
This is a 5-hour video of a woman walking to get antenatal care. It’s powerful in showing us the reality of pregnant women around the world.

If you’re here, chances are you’re very curious and/or passionate. Here are some documentary recommendations:

17 yo building better maternal healthcare in developing countries.

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