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."
Here are a few examples of winners from previous years, as well as competitors from this year:
A leading cause of death for low-birthweight babies around the world is acute respiratory infection. When newborns have trouble breathing, they can be treated with Continuous Positive Airway Pressure, a type of machine that forces oxygen and pressurized air into their lungs. The only problem is that the equipment costs $6,000 in most countries.
But by using cheap materials -- an aquarium pump and a water bottle for air pressure relief -- researchers at Rice University created a $400 version. In its trial run in Malawi, the team said it brought the survival rate for newborns with respiratory distress up from 24 percent to 65 percent, and soon they'll be trying out the tool in government hospitals across Malawi.
If you're giving birth in the U.S., there's about a 4 percent chance the baby will get stuck and the doctor will need forceps or a vacuum to help pull it out of you. If you're in Chad, there's almost zero chance that whoever is attending your birth either a) has access to forceps or a vacuum or b) knows how to handle forceps well enough to prevent hurting the baby.
The Odon device was invented by an eponymous Argentine auto mechanic who saw a YouTube video about people removing wine corks from bottles with plastic bags. This process apparently reminded him of the miracle of life, and he eventually patented a device that allows a medical worker to pull an obstructed baby out of a uterus using a plastic sleeve.
Here's how it works: An applicator pushes the sleeve into the uterus and around the baby's neck, and then an air pump inflates a chamber at the bottom of the sleeve to hold it in place. Then the birth attendant yanks on the sleeve until the baby crowns, and then he or she deflates the sleeve.
The demo looked pretty violent, but it's apparently safer and easier to use than forceps (at least for the 30 women they've tried it on so far). In any case, it's much cheaper than a vacuum. The Odon is now part of a WHO-approved study in Argentina.
Fetal heart rate is one of the few clues to a baby's well-being while it's still inside its mom, but heart rate monitors are (say it with me) too expensive for widespread use in many countries. This hand-cranked version, created by the nonprofit Save the Children, can be used in areas that lack consistent electricity. As a bonus, when moms visit their nearby clinic to use the monitors, the idea is that they feel motivated to come back to the clinic when it's actually time to give birth -- which is good, since giving birth at home, at least in the developing world, is dangerous. Save the Children has already won a grant for the device and hopes to expand the product throughout Uganda.
An abnormal breathing rate can be a sign of pneumonia, but a silver-dollar-sized, $20 tchotchke called Inspire aims to help untrained parents in developing countries spot rapid breathing in time. Also powered by a hand crank, the monitor blinks when the breath rate is off. It attaches to the child with a silicone pad that doesn't need to be replaced after each use, so just one device can serve an entire village. To keep it from getting lost, its inventors also attached it to an 80s-style slap bracelet that its owner can wear around as sort of a more-useful-than-average fashion accessory. The team behind Inspire was competing for a grant for field tests, but they did not advance.
Intrauterine devices are a cheap, effective form of birth control, but in some countries, women either don't understand how they work, or providers aren't trained to insert them properly -- especially after a woman has already given birth. Jhpiego Corporation in Baltimore created this low-tech simulation model that allows health practitioners to demonstrate how IUDs work. It's made of cloth, with netting representing the "uterus," so it only costs $50 instead of the $800 or so for the kind of model you would find in an American clinic. Jhpiego's replica is also foldable and portable, so health workers can pack it away in a carrier and take it on a family-planning roadshow of sorts. The device has already been awarded funding and is being tried in Pakistan.