Childbirth still kills far too many women and babies worldwide—but millions of those lives could be saved by deploying seven simple and affordable innovations, according to a new report on maternal mortality from the Bill & Melinda Gates Foundation.
In its seventh annual Goalkeepers Report, which measures global progress toward the United Nations’ Sustainable Development Goals, the researchers show that progress toward ending maternal mortality has stalled worldwide since the COVID-19 pandemic diverted resources away from this critical goal. Nearly 800 women continue to die in childbirth every day, and 74 percent of child deaths occur during a child’s first year. Even in high-income countries like the United States, maternal mortality rates are rising, particularly among Black women.
“When a mother dies during childbirth, the future dies with her. This is fundamentally about human beings,” Mark Suzman, CEO of the Gates Foundation, said on a conference call announcing the release of the report.
But there is hope. The Gates Foundation report outlines seven interventions that could save as many as two million mothers and babies by 2030. Although some of these strategies are born of cutting-edge research and technology—like AI ultrasounds—most are strikingly simple.
1. New guidelines for treating postpartum hemorrhage
Severe bleeding can kill a woman within hours after childbirth and, as a result, postpartum hemorrhage is the leading cause of maternal mortality. But all too often health-care workers consistently underestimate blood loss in new mothers (postpartum hemorrhage is generally defined by the loss of more than 16 ounces of blood within 24 hours of childbirth).
Instead, the Goalkeepers Report recommends labor wards take a cue from surgical wards by using calibrated obstetric drapes—essentially plastic bags that collect blood—to accurately determine how much blood a mother has lost. “It’s super simple, it’s just something that we haven’t really deployed in the labor ward very often,” says Rasa Izadnegahdar, the Gates Foundation’s director of maternal, newborn, and child health discovery & tools.
Current guidelines to treat postpartum hemorrhage recommend administering five separate treatments—including uterine massage and IV fluids—sequentially. But a study published earlier this year, funded by the Gates Foundation, showed that administering these treatments all at once, in combination with an obstetric drape, reduced cases of severe hemorrhage by 60 percent.
2. Probiotics, but for babies
New research has also shed light on the risks facing newborns and children under five that make them more vulnerable to diseases like pneumonia.
One of the chief risks that make newborns and children under five more vulnerable to diseases like pneumonia is malnutrition, according to data provided by Child Health and Mortality Prevention Surveillance (CHAMPS), a global health surveillance program funded by the Gates Foundation.
The Goalkeepers Report estimates that the lives of 300,000 babies could be saved simply by giving newborns probiotic supplements containing bifidobacteria, which break down the sugar in breast milk and help babies absorb nutrients more efficiently. Expectant mothers can also give their children a head start toward a healthy birth weight and gut microbiome by consuming these supplements in late pregnancy.
3. Better neonatal supplements
Expectant mothers have long been recommended to take neonatal vitamins packed with iron and folic acid to support the health of their child. But Izadnegahdar says that there are new options on the market now that are even more effective.
Known in the public health sphere as multiple micronutrient supplements, this new generation of supplements contains 13 additional nutrients, including vitamins A, D, E, and C, as well as zinc and other elements.
Not only are they better tolerated than iron-folic acid tablets, which can cause nausea and constipation, but they are shown to substantially reduce the likelihood a baby will be born prematurely and underweight. “We know being born with a high birth weight provides benefits through life,” Izadnegahdar adds.
4. Iron delivered by IV
Anemia—when people lack enough healthy red blood cells to carry oxygen to the body—is another leading cause of maternal mortality. Often caused by an iron deficiency, it can make a woman more likely to bleed heavily, and can lead to infection and postpartum depression, Bosede Afolabi, an obstetrician and researcher based in Lagos, Nigeria, said in the conference call.
While iron supplements might help women with milder cases of anemia, another treatment has been shown to be even more effective for women with more severe anemia: IV transfusions that deliver iron into the bloodstream immediately.
This method is admittedly more expensive on face value than administering oral iron supplements, said Afolabi, who is currently researching this method with funding from the Gates Foundation. But she argues that it’s more cost-effective in the long run: One 15-minute IV drip provides the equivalent of taking four tablets a day for four weeks.
5. Corticosteroids for preterm babies everywhere
Babies that are born prematurely often struggle to breathe because their lungs didn’t have time to finish developing in the womb. The good news is that there’s already a proven treatment, says Izadnegahdar: When a woman shows signs of preterm labor, physicians can administer corticosteroids to help speed up the baby’s lung growth before birth.
Although this treatment is common in the U.S. and other high-income countries, the Goalkeepers Report estimates that making it the standard of care in sub-Saharan Africa and South Asia could save 144,000 lives by 2030.
6. Antibiotics to prevent sepsis
Sepsis—which occurs when the body has an extreme and dangerous reaction to an infection—is another major cause of maternal mortality. In the U.S., 23 percent of maternal deaths are caused by sepsis.
Many of these deaths could be avoided in the future by giving women a single dose of the antibiotic azithromycin during labor. While this drug has long been shown to reduce infection among women who deliver by cesarean section, recently published results of a clinical trial funded by the National Institutes of Health and the Gates Foundation found that the common antibiotic also reduced the risk of postpartum sepsis among women who deliver vaginally by one-third.
7. AI ultrasounds
“The ultrasound is the cornerstone of pregnancy,” Izadnegahdar says, explaining that the age-old technology helps physicians understand how a pregnancy is progressing and identify problems early on. In many low-income settings, however, there simply aren’t enough trained obstetricians and radiologists who can read an ultrasound.
That’s where AI-enabled portable ultrasounds come in: These devices are plugged into a mobile phone and, with a few quick swipes of a probe, can identify the position of the baby, position of the placenta, and gestational age in about five minutes. Unlike large language models like ChatGPT, this computer vision AI is stunningly accurate, Izadnegahdar says, because it is trained on data from images and data instead of language inputs. “You can do just as well as a radiologist.”
Although AI ultrasounds may sound like the treatment of the future, Izadnegahdar argues that the beauty of these seven interventions is that they are eminently doable since they leverage drugs and technologies that are already available.
“We tolerate substandard products for moms in labor across the board. Why do we do that?” he asks. “My whole point is that the innovations are there, they’re low cost, and we [need to] get the global health community to pay attention to these in the same way that they do to COVID or to malaria.”