WHEN A WOMAN heads to the delivery room, the expectation is that a happy ending is all but guaranteed. This story is true for most women in developed countries where health care works well due to consistent investment over time. (African-American women are a notable exception because access to medical institutions and interventions is impeded by underlying racism in America’s health-care system. They are more than three times as likely to die in childbirth as their white counterparts; Native American women are also more likely to die than their white counterparts). But joyous outcomes are by no means certain for most women who live in countries still struggling to develop.
Fully 99% of maternal deaths occur in developing countries, according to the World Health Organisation. More than half of these deaths are in sub-Saharan Africa. UNICEF’s data estimates that in 2017 there were 533 maternal deaths per 100,000 live births—200,000 deaths a year—in Africa. Thousands of families and loved ones have been confronted by the devastating news that the women in their lives are no more. Three-quarters of maternal deaths on the continent relate to severe bleeding (mostly after childbirth), infections (usually after childbirth), high blood pressure during pregnancy, complications during the delivery of a child and unsafe abortions. Other deaths are associated with diseases such as malaria and AIDS in pregnancy.
Globally progress is being made on reducing maternal mortality. In 1990 some 532,000 women died. In 2015 that number was 303,000. But the journey towards safer pregnancies in Africa is strewn with several obstacles.
Lack of access to health care is the most significant of these. Persistently low economic output, cultural norms (such as beliefs in herbal medicine and cultural rites and superstitions), the distance to health-care facilities that can deliver appropriate care and a lack of critical medical information are some of the reasons that prevent women from getting the help they need during pregnancy and childbirth. According to a survey by the Wellcome Trust, a large medical research foundation, and Britain’s former Department for International Development, in 2015 only 16 out of the 48 African countries assessed had made it possible in 80% of the country to reach a hospital within two hours. In many places hospital visits depend on the availability of transport for long distances. In the absence of transport, those in need inevitably have to resort to home care.
If women manage to make it to the hospital, there is no guarantee that they will receive adequate care. A very visible symptom of this problem is the dearth of trained medical personnel. According to the WHO, in 2020 there were an average of 2.92 doctors per 10,000 inhabitants in Africa. In Australia there were 41.3 per 10,000; in the UK 30.4.
Brain drains endanger women. Consider Nigeria as an example. The Nigerian Medical Association reports that between 2016 and 2018, 9,000 medical doctors of Nigerian origin emigrated to Britain, America and Canada. Such departures make pregnancy and birth more risky for Nigerian women. Thousands and thousands of births are not assisted or supervised by skilled health personnel, affecting the provision of antenatal and postpartum care. Better working conditions, properly equipped hospitals and improved wage structures might all help to convince more doctors to stay.
Of course, such interventions in Nigeria and elsewhere require funding. In April 2001 African Union member states met in Abuja, Nigeria’s capital, and promised to allocate 15% of their government budgets to health. Some 15 years later, only two countries—Rwanda and South Africa—had reached the 15% target. And 19 countries were spending proportionally less on health than they were in the early 2000s.
In the face of declining revenues and debt servicing, governments across the continent are unable to commit the funding to build health infrastructure that guarantees safer pregnancies for women across Africa. To fill that gap, technology-driven solutions designed and run by local health-tech startups have emerged. Collectively, they address many of the pain points that prevent the provision of adequate care for pregnant women in Africa.
There are startups tackling pen-and-paper data storage, inefficient supply chains for medical products, inadequate medical equipment and financing, and last-mile health-service delivery. The improvements facilitated by such startups allow the existing medical workforce to help patients more effectively. That lessens the devastating impact of brain drains across the continent. I hope that new startups appear that develop Africa’s pipeline of medical talent, too.
Funding health-tech startups so they can scale their solutions across borders is critical to ensuring safer pregnancies for Africa. Despite solving different problems in health care, these startups are united by their ability to scale rapidly. The work they do directly affects the quality of health care available to pregnant women in a variety of ways.
LifeBank, which I set up in 2016, was inspired by the experiences of African women dying from postpartum haemorrhages. That is because women often lack access to safe blood delivered quickly to hospitals. In response we built a data and tech-driven platform that connected hospitals to blood in minutes. Since then, LifeBank has expanded its mission by building a safe supply system for oxygen, medical consumables such as gloves, syringes and catheters, and other equipment. All these products are accessible via a central marketplace platform. Every delivery made to a hospital helps pregnant women in the three countries LifeBank operates in—Nigeria, Kenya and Ethiopia—to gain access to high-quality supplies that support pre- and post-delivery care.
Medsaf, a platform founded in 2016 by another female health-entrepreneur, is changing the way pharmacies and health-care facilities approach the procurement of pharmaceuticals. The company has built a one-stop shop so that facilities such as hospitals and clinics can order, manage and track needed medication. It connects them directly with manufacturers, ensuring quality control and cost efficiency. While its core operational presence is in Nigeria, MedSaf has its eyes on other emerging markets. For pregnant women, it can ensure they get enough folic acid and vitamin B12.
These companies are just the beginning. Funding is not growing as quickly as African women need. Investment data from Briter Bridges, a market analytics platform, shows that African health and biotech startups raised $392m in funding in 2021—an impressive increase from $110m in 2020. However, funding for health tech accounts for only 8% of the total funding raised in 2021 for African startups; 62% of the money went to fintech startups.
These statistics are a call to action. If we are serious about saving pregnant women across Africa, we must ensure their pregnancies end in predictable joy. That means boosting investment in businesses building the health systems of the future. A baby’s birth should not mean a mother’s death.■
Temie Giwa-Tubosun is an entrepreneur and the founder of LifeBank.