In 2020, scientists around the world banded together to develop and test a highly effective vaccine against a daunting new virus, turning the tide in the global COVID-19 pandemic and saving untold lives.
Yet in the same span of time, a staggering 287,000 women worldwide died during and following pregnancy and childbirth—almost entirely from preventable causes. And yet very few rushed in to stop the proverbial bleeding.
Maternal mortality is an urgent and pervasive problem robbing the world’s children of their mothers. Melinda French Gates, co-chair of the Bill & Melinda Gates Foundation, says this doesn’t have to be the case.
“In this day and age, 800 women should not die every day of maternal mortality,” she tells Fortune.
In its annual Goalkeepers report released Tuesday, the Gates Foundation lays out the staggering numbers surrounding maternal mortality and offers several interventions it says have the potential to save thousands of lives in low- and middle-income countries (LMICs) around the world by 2030.
Coauthored by French Gates and Bill Gates, the report tracks progress on the United Nations’ sustainable development goals, which aim to, among other things, reduce the global maternal mortality rate by more than half—from nearly 160 deaths out of every 100,000 live births to less than 70.
But as French Gates notes in the report, “we are far off track.”
Inexpensive life-saving interventions
Every two minutes, a woman dies during pregnancy or childbirth. The majority of those deaths occur in low- and middle-income countries, where progress in the fight against maternal mortality has stalled. At the same time, maternal death rates have worsened in higher income countries like the United States.
“There are things we can do about it and ways we can intervene—we wanted to show people what's possible,” French Gates, says. “It's still a very dangerous day when a woman goes in to deliver a baby”—regardless of what part of the world she lives in.
The report highlights tools experts consider to be the most impactful in curbing deaths of new moms—many of them inexpensive or already widely used to treat other conditions.
Among them: a simple, inexpensive plastic sheet.
About 70,000 women worldwide experience postpartum hemorrhage, or excessive blood loss following delivery, according to the World Health Organization. That makes bleeding to death the leading cause of maternal mortality. A $1-$2 plastic sheet hung at the edge of a bed could save a life each time it’s used, according to the report.
The drape measures the amount of blood lost and provides a quick and objective visual cue to hospital workers that a patient is in danger. When healthcare workers used the drapes in a trial and performed treatments to stop bleeding simultaneously, rather than sequentially, the number of severe cases of bleeding dropped by 60%.
Other novel treatments include a 15-minute intravenous iron infusion that can prevent or treat severe anemia in pregnancy—a common cause of postpartum hemorrhage—and administering azithromycin, an antibiotic widely used to treat eye and respiratory infections. When given to mothers, azithromycin can cut the incidence of maternal infections, which can lead to sepsis—a life threatening inflammatory response. During a trial across Sub-Saharan Africa, the inexpensive medication reduced maternal sepsis cases by one-third.
“These interventions have the potential to avert about 1.9 million cumulative deaths in low- and-middle income countries by 2030,” said Laura Lamberti, PhD, deputy director of Maternal, Newborn, & Child Health Discovery & Tools for the Gates Foundation, in a recent press briefing.
Utilizing these simple interventions 60% of the time could save nearly 6.5 million mothers’ lives by 2040, she added.
‘Abysmal’ trend in maternal mortality
Despite the availability of several low-cost interventions, mothers continue to die at an appalling rate. “I can say that, generally, the trends for maternal mortality are quite abysmal and quite challenging,” Lamberti said at the briefing.
Several hurdles prevent access to and adoption of these lifesaving measures. Chief among them: investment, scale, and quality control.
Countries riddled with conflict are incredibly difficult places to give birth. It may be impossible for a woman to get to a medical facility—and if she does, it might lack basic equipment.
It takes “focus and goals” and “more outside government investment” for countries to turn that trend around, French Gates says.
What's more, “we need to have the right regulations and policies so that these interventions can be scaled up quickly,” she adds.
While the interventions themselves may be cheap, distribution is not. Distributing them widely requires both philanthropic and government money. “And quite often,” she adds, “government funding will go to health innovations for men, not necessarily for women.”
French Gates points to another critical roadblock in leveling maternal mortality rates: societal attitudes towards women and the devaluing of their care.
“The fact that the global community tolerates this lower quality, substandard approach to women’s health is completely a gendered issue,” Dr. Rasa Izadnegahdar, director of Maternal, Newborn, & Child Health Discovery & Tools for the Gates Foundation, said at the briefing.
Maternal mortality in the U.S.
While the primary focus of the report is maternal mortality in LMICs, the authors note that the same approaches that work in the developing world can help reduce the climbing maternal mortality rates in the U.S., where Black and Indigenous women are three times more likely to die in childbirth than white women, according to the U.S. National Institutes for Health.
Tennis great Serena Williams is a prominent example of how dangerous it can be for Black women to give birth in America. Williams’ doctors ignored her pleas, and she nearly died from blood clots after giving birth.
“The fact that Serena Williams went in the system and had to try and convince people and they wouldn't listen to her—are you kidding me?” French Gates says.
Standardizing care is key, Izadnegahdar notes. When providers use a routine approach to care based on “defined triggers” rather than “subjective assessments,” disparities decrease, he said.
Philanthropy and pressure
The foundation is offering more than thoughts and prayers when it comes to combating maternal mortality, French Gates maintains.
“We can step up with funding ourselves to demonstrate we walk the walk,” she says. “We can call on other philanthropists to step up the funding, and we can call on governments to step up their funding and put pressure on them.”
For those who think that the maternal mortality crisis is for lawmakers and medical professionals to sort out, French Gates insists that it’s up to all of us to take action.
“We need citizens to step up and push their own governments, to use their voice to say we care about moms, we care about babies. If there's something that's not very political—or shouldn't be—it’s moms and babies surviving.”
