The Massive Market Failure of Motherhood

For everyone who has children, nieces, nephews, younger siblings, and/or a soul, safe childbirth is deeply personal--not only because of what has happened to some of us, but also because of what could have happened and what still might happen. Nearly four million women give birth in the United States each year, and more than 50,000 of these mothers experience severe, life-threatening complications. This makes the United States among the most dangerous countries in the developed world to give birth. In much of Sub-Saharan Africa, maternal mortality is going down. In the United States of America, maternal mortality is going up and has been going up steadily for more than 20 years. Perhaps most disturbingly, we don't even fully understand why this is happening.

One thing is clear: with rare exception, having a baby requires help from caring and skilled fellow humans. Most species do not have this requirement. Gorillas deliver their own babies, often with the infant facing the mother as he or she exits the birth canal. Homo sapiens are different. Our ability to walk upright gives us a narrower pelvis. Our social intelligence has required a larger frontal lobe of the brain, which means our heads navigate the birth canal quite differently--in fact, we're most often born facing away from our mothers. Fortunately, the same traits that make it more difficult for us to negotiate the birth canal also make it easier for us to help each other out. We have dexterity. We have empathy. For at least as long as there has been a written record, midwifery has been a cornerstone of human civilization.

Nonetheless, simply being willing and able to help appears to be inadequate. Too much help, incorrectly applied, can be dangerous. Over the last generation of American moms, we have misguidedly attempted to make childbirth safer by intervening much more than strictly necessary, delivering one in three human beings through C-sections (a form of major abdominal surgery). Although these surgeries are sometimes lifesaving, since the 1970's C-sections have become 500 percent more common while our rates of childbirth complications have not improved. In fact, they have actually gotten worse. Nearly half of the C-sections we perform appear unnecessary in retrospect and account for the plurality of the avoidable childbirth complications that we see, including sepsis, organ injury, and hemorrhage.

Our problem does not appear to be lack of effort. It appears to be a surprising lack of investment in sound solutions. Government investment requires collective action, yet when it comes to maternal health, we have an alarming lack of urgency. Venture investment requires big bets and large returns, yet when it comes to maternal health we are too risk-averse. Childbirth--despite being the most common reason for hospitalization in the United States--remains rigidly fixed to a failing model of care that has historically been seen as a massive loss leader for health systems and hospitals. The results are tinged with irony: While over $500 billion is spent annually on healthcare during the last nine months of life, less than $50 billion is spent on the arguably higher leverage first nine months of life. Silicon Valley, typically agile and wily, has remained curiously indolent. According to startup incubator Rock Health, between 2011 and 2015, digital health ventures focused on women's health (pregnancy, fertility, and "women's health" at-large) raised $146 million dollars collectively in funding. By comparison, a single venture capital firm recently raised $220 million to discover new solutions for male-pattern baldness.

Failing our mothers is bad enough, but not knowing how to do better is worse. Academic research on maternal health is limited, partly because pregnant women (quite reasonably) prefer not to be experimented on, and partly because opportunities for research funding are so scarce. Even when we have knowledge, we fail to translate it in a market-oriented way. A quick Google search will display the best cities to retire in. Why don't we know the best cities to give birth in? To move forward, safe childbirth needs to be more than a cause. This past National Women's Health Week and Mother's Day, many of us took the time to tell our mothers we love them. It is time to put our money where our mouth is.