Every year, one million babies die the same day they were born, almost always in poor countries. Besides the sheer human tragedy of this fact, it has significant ramifications for the economies of developing nations, as well.
Here's what one popular theory suggests: When children frequently die in infancy, parents have a lot of kids in order to maximize the chances that some of them will survive, and they also invest less in each child. When fewer children die, meanwhile, fertility rates tend to decline, and something called a "demographic dividend" opens up: Parents are less burdened by hungry mouths to feed, more moms can work, parents invest more in each child, and economic growth accelerates. Many economists believe that this trend was in part responsible for East Asia's remarkable growth over the past half-century.
The U.S. government wants this dividend to come to less-developed countries, too, and spends about $2.5 billion each year on maternal and child health abroad to bring it to them.
"Fragile countries need to start this demographic transition," United States Agency for International Development Administrator Rajiv Shah told me in an interview. "You cannot have a successful society if women are dying of childbirth and if children go off to live with relatives or in orphanages."
The agency has been working on maternal health since 1989, but now, USAID has partnered with foundations and the U.K. and Norway governments, among others, for a competition called Saving Lives at Birth, which aims to find cheap, effective answers to maternal and child health quandaries in developing countries.
"We know that a great majority of those deaths happen for children born outside of a medical facility," Shah said. "So, we thought, let's invent new solutions that can tackle that precise problem."
More than 1,500 people submitted proposals, but only 22 were awarded grants of either $250,000 or $2 million after a massive science-fair style event yesterday. USAID's contribution will be $10 million over the five years of the program.
Among the competitors were everything from a ketchup-packet style container for dispensing HIV drugs (it won a grant), to a special pair of pants made from cloth and bicycle tubes that, when fitted with a soccer ball, can stop hemorrhaging during birth. (The contraption did not win a grant, but looks amazing, so here's a photo.)
Stories on innovation can be a rare bright spot in coverage about low-income countries, but it's worth remembering that seemingly ingenious, well-intentioned "solutions" for the developing world fail all the time. A merry-go-round that was supposed to be a "fun" water pump was so inefficient that after it was installed, it was found that kids would have to "play" on it around the clock for it to work. The much-heralded One Laptop Per Child barely increased test scores.
We're infatuated with the prospect of technological solutions to these problems--baby warmers, say. You can still find high-tech incubators in rural hospitals that sit mothballed because a replacement part wasn't available, or because there was no electricity for them.
It's hard to know which devices will prove lasting, but there are a few things USAID and its partners look for in competition winners to reduce the odds that the inventions will flop.
First, they must be cheap. Though the grant money will allow these devices get their start, the successful ones will eventually be perpetuated by purchases on the ground in the host country, and they'll be re-usable and require few replacement parts.
Second, Shah says USAID and the other partners follow up on the grantees to make sure that they remain functional in the field, so the inventors must ensure the host communities want to use the product.
And as Gawande wrote, sometimes instilling lasting change in individuals' routines is much harder than dreaming up a new gadget. Most of the inventors I spoke with included some aspect of behavior change in their project, like training sessions or education programs.
I asked Shah why USAID wouldn't just funnel their money toward things like hospitals and roads in developing countries, rather than supporting solar suitcases and the like. Some countries lag so far behind in maternal health, he said, that the agency thinks it's best to work within the nations' current parameters -- home births, unsanitary conditions, and all -- rather than focus on larger-scale development.
"A young girl born in South Sudan today is more likely to die in childbirth than to complete a secondary education," he said. "We can't wait another 20 years for South Sudan to look like Iowa."