Tell us about the social impact of your innovation. Please include both numbers and stories as evidence of this impact
Having aimed to reduce the number of women dying in obstructed labor by 75% within 2 years, that number was down 100% within 4 months. As of January 2010, no woman had died of obstructed labor since May 2008 in the project area, for 21 months and counting. Obstructed labor was previously reported to be the main cause of birth-realted maternal deaths, as in other geographically remote areas. While the aimed for 50% reduction in new obstetric fistula cases has not quite been achieved yet, total birth-related mortality may have been reduced by 30% in the project area the 2nd year, in a country where 1 of every 7 women sooner or later dies in childbirth, the worst such statistic in the world. To me, a story that tellingly illustrates the project's impact is about the woman who threatened divorce in her strongly male-dominated society if her husband would not go for his annual re-training as a village volunteer. He had things to do in his fields, he said. She was livid. When he puzzled asked why, she said, essentially, "Don't you remember when our youngest child was born, and I was having difficulty? Those people came even in the middle of the night, and six people lifted me into that ambulance! And they didn't even charge us money! I and our baby boy survived in fine shape. And you want to go to your field when these people invite you for training???!!!??? Go right ahead!! But I won't be here when you return!" It was the husband himself who told us. He had chosen to attend the 3-day training course in the spring of 2009 after all. When mothers survive, existing children also survive better. The impacts on many levels when preventing women from becoming socially outcast and economically unproductive for the rest of their lives are myriad, as many as one can imagine and then some! Preventing obstetric fistula means preventing women from leaking urine and/or intestinal content day and night, even in their sleep after a birth that lasted too long, almost always a birth where the baby dies.
Problem: Describe the primary problem(s) that your innovation is addressing
The primary problem that this innovation addresses is the fact that, in spite of all of the money and effort thrown at the problem since then, about as many women and young girls in puberty die in childbirth today as during the late 1960s, roughly 500.000-600.000 of them each year. Most prevention interventions have had a long-term horizon for efficacy (such as "educate all girls", "a midwife for all", and "upgrade all hospitals everywhere", etc), all of which are important, even essential things to do. But the question remains as to whether the international community must per force sit idly by until these long-term interventions have effect, or whether one can apply relatively modest additional funds in a strategic manner to achieve a much faster effect, whether one can maximize the efficacy of what limited resources actually already exist in developing country settings, even while doing those other good things. Has the world really no choice but to kill another 14 million women or more, while waiting for the long-term solutions to have effect???
Actions: Describe the steps that you are taking to make your innovation a success. What might prevent that success?
To make the innovation a success, I first got together with the US Centers for Disease Control (CDC) and then also the UN Population Fund (UNFPA) with partial Canadian (CIDA) funding. We organized a global policy retreat of reproductive health experts to consider the idea, the innovation, in 2005. Then I worked with the government of Niger to plan and then implement the innovation in a remote rural, multiethnic, multi-language population of about 100.000 nomads and subsistence farmers, where health indicators and infrastructure were no better than the national averages. Having proven the innovation works on that scale, we are now extending it to cover an estimated 263,000 people in geographically areas that are non-contiguous. And I organized a successful international meeting at The Carter Center March 9-10, 2010 so "the international community" could consider whether this and selected other initiatives, using different approaches, may be ready for scaling up. Based on that meeting we are now also exploring whether it may make sense to implement the innovation in a specific East African country as an additional next step. And we continue to seek Niger's government approval to expand the program to also prevent women from bleeding to death at birth, through the same infrastructure, the same organizational approach.
Results: Describe the expected results of these actions over the next three years. Please address each year separately, if possible
The "official" aimed for result, chosen in advance, is to reduce obstructed labor deaths by at least 75%, to reduce obstetric fistula incidence by at least 50%, and to prevent at least 50% of post partum hemorrhage deaths, each within two years, in every area where this innovative approach is introduced, and to achieve further improvements from there on. Having reduced obstructed labor mortality by 100%, to zero new cases within four months, thus surpassing the aimed for or "expected" result for that parameter, one has of course raised the bar for that outcome in subsequent implementation areas. We will nevertheless stick to the initially aimed for or "expected" results goal as being the "official" one, partly because the project was severely criticized for having chosen goals that were much too ambitious and presumed to be unrealistic. If obstructed labor mortality is reduced very quickly in subsequent geographical implementation areas, one will adjust the "expected" results in an even more ambitious direction.
If your innovation seeks to impact public policy, how?
This innovation seeks to influence public policy by first showing that women's lives can be rapidly saved and their dignity protected, to a degree that makes it politically and policy-wise unacceptable for the international community and national governments to stand idly by as one waits for longer-term interventions to bring the number of maternal deaths and obstetric fistula cases down. One organizational tool that the innovation uses is to regularly share outcomes information (the good news and the bad) with policy makers, so they align their policies in ways that speed the prevention of birth-related deaths and speeds the rapid prevention of obstetric fistulas.