Thank you for joining me this afternoon.  I am Jonathan Fanton, President of the John D. and Catherine T. MacArthur Foundation.  I am joined by Dan Pellegrom, President of Pathfinder International, our partner in an important new initiative we announce today.

The MacArthur Foundation is a private, non-governmental grant-making institution based in Chicago, but working in 60 countries on conservation, human rights, peace and security, and population and reproductive health.  I am here because we have a long standing interest in reducing maternal mortality with a focus on India, Nigeria, and Mexico. India and Nigeria between them account for about one-third of the world’s total incidences of maternal mortality.

Each year, in developing countries across the world, more than 500,000 newly delivered mothers die during pregnancy and childbirth.  Consider the immense personal suffering that lies behind these numbers: with each death: a family suffers a tragic loss, children face economic hardship, and whole communities are weakened.  The UN Millennium Development Goal number 5 aims to reduce maternal mortality by 75% by 2015.  But we have a long way to go – so far the ratio and total numbers of deaths have come down only sightly.

Postpartum hemorrhage is the most common cause of maternal mortality, accounting for almost a third of maternal deaths.  We want to reduce that number dramatically in the years ahead.

There is hope.  With simple technology, modest investment, and elementary training, postpartum hemorrhage can be reduced by as much as 80%.

Which is why we are here today.  I am pleased to announce that, to reduce maternal mortality and morbidity due to postpartum hemorrhage in India and Nigeria, the MacArthur Foundation is giving an $11 million grant to Pathfinder International.

This intervention package -- if applied globally -- has the potential to prevent about 130,000 deaths per year.

How can this be achieved?  With a simple package that consists of four elements centered on three simple technologies:

1. The use of misoprostol tablets to prevent PPH (misoprostol causes the uterus to contract after delivery)
2. A calibrated blood-collection drape that takes the guesswork out of estimating how much blood has been lost and so helps diagnose PPH as early as possible;
3. An Anti-Shock Garment that stabilizes hemorrhaging patients; and
4. Transportation to a health facility where a skilled medical provider can determine the underlying cause of the hemorrhage and give appropriate treatment.

This combination has the potential to be remarkably effective in preventing and treating PPH.  Recent research in India has shown that misoprostol tablets, taken just after a child is delivered, can prevent up to 50 percent of hemorrhage cases by closing off the blood vessels in a timely fashion.  The calibrated blood drape [show drape] is a simple piece of plastic that helps birth attendants diagnose hemorrhage in its earliest stages, important because people often underestimate how much a woman is bleeding and how close she is to life-threatening levels of blood loss. The Anti-Shock garment, the most innovative element of the package, stabilizes the hemorrhaging patient and allows her to be transported to a clinic or hospital.  It can be effective up to 2 to 3 days, if necessary.

Let me describe how the AntiShock Garment (ASG) works:  [Show ASG]  the ASG is made of neoprene, which has three-way elasticity, and is fitted with robust Velcro fasteners.  It is applied tightly to the lower body, where it exerts a counter-pressure that shunts blood from the lower extremities and pelvis to the vital organs.  As it controls bleeding and reverses shock, the ASG buys time for a woman in hemorrhage, ensuring an adequate blood flow to her heart, lungs, brain, and kidneys. 

With MacArthur’s support, the Women’s Global Health Imperative at the University of California has conducted research on the effectiveness of the ASG in Egypt, Nigeria, and Mexico.  The findings are impressive: the ASG alone has the potential to reduce mortality among hemorrhaging women by up to 60 percent.  The research has taken place both in large city hospitals and in rural public health centers. Stories are told of women in shock being brought back from the brink of death, and their families celebrating their survival in wonderment.

The ASG is well adapted for use in rural areas and places not well served by medical facilities.  Using the ASG requires no medical education or background. Any member of the community can be trained to use it.  The ASG is lightweight, inexpensive, and washable, allowing it to be used dozens of times.  It costs only $130 at present, and we expect that the cost could be lower when higher quantities are manufactured.  While the ASG has great potential, we expect that there will be many challenges in the field.  For example, as I heard during a recent visit to Nigeria, outreach to women and their families will be crucial so that they understand and trust that the ASG can work if it is applied in time.

The four-part strategy comes from many years of research and engagement in the field.  The Population and Reproductive Health program of the MacArthur Foundation has worked to reduce maternal mortality for the past five years in our three focus countries:  India, Nigeria and Mexico.  Our projects go beyond postpartum hemorrhage alone, and have included training non-specialist physicians in Emergency Obstetric Care and nurse midwives in skilled birth attendance; educating Auxiliary Nurse Midwives, community health workers, and traditional birth attendants to recognize and refer serious problems during deliveries; and raising community awareness about the fact that death in childbirth is preventible. 

One of the keys to success in reducing maternal mortality is indeed to culitvate informed and engaged communities that are equipped to recognize an emergency, intervene effectively, and quickly transport women to places that offer emergency obstetrical care.  Postpartum hemorrhage prevention begins in homes and communities.  It must extend to transportation networks, to Primary Health Centers, and to secondary and tertiary medical facilities, so that women are protected where they deliver, on their way to treatment, and in the medical system.

The grant we announce today is aimed at introducing the PPH package in enough places and at sufficient scale that it will not only save many lives but also provide decisive evidence that it works and is cost-effective.  When that is accomplished, we hope that the program will be implemented nation-wide in our focus countries, and across the world.  We are fully aware that no private donor, no matter how large, could ever substitute for a government’s role in providing health care to its citizens.  I recently met with the President  and the Health Minister of Nigeria, both of whom are making maternal mortality reduction a priority and pledged to work with us.

MacArthur is committed to this goal; reducing maternal mortality is one of the two priority themes of our Population program.  But it is part of a broader  strategy.  While we work to increase the chances that women will have safer pregnancies and deliveries, we also aim to improve all aspects of reproductive health, to educate young people, and to promote women’s rights.  And when women and their families are given good care and counseling we believe they make sensible individual decisions about family size.

The iniative we announce today has the potential to make the Millennium Development Goal #5 a reality, to save hundreds of thousands of lives, and to build communities that are stronger and more secure.

The MacArthur Foundation is dedicated to this goal, and proud of our association with Pathfinder International, an organization that has for fifty years worked to “make every child a wanted child” and to advance reproductive health.   We look forward to seeing this project unfold over the next four years.  We are confident Pathfinder will show the world that postpartum hemorrhage can be reduced by 80%, if we apply the tools that are available; inexpensive tools, easy to use, that pay huge dividends.

And now I ask Dan Pellegrom to tell you more about Pathfinder’s important work.

Population & Reproductive Health, Health, India, Nigeria, Population