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Learning across boundaries to end preventable maternal deaths

Yale Medicine Magazine, 2019 - Autumn


Every two minutes, a woman dies from pregnancy- or childbirth-related complications. Mary-Ann Etiebet, MD/MBA ’03, wants to change that. In 2016, Etiebet joined Merck to be the executive director of Merck for Mothers, a global initiative focused on ending preventable maternal deaths. She uses her background in medicine and business to advance innovative multisectoral approaches to reducing maternal mortality around the world.

Etiebet, who grew up in Nigeria, always knew she was going to become involved in health care—she just didn’t know how. She decided to pursue medicine when on a drive to school one day, she spotted a teenage girl with rickets walking down the road with her younger brother. The brother wore a school uniform, but the young girl did not, and could no longer pursue her education.

“I realized that without good health you couldn’t realize your full potential, or completely have economic independence,” Etiebet said. “Even now, that moment is a reminder that we cannot separate the effects of health from broader societal opportunities.”

Etiebet pursued her higher education in the United States, studying political science as an undergraduate at Yale before continuing on to the MD/MBA program. She realized that to effect the kind of institutional changes and sustainable health care outcomes she envisioned, she would need to understand medicine, society, business, and policy—and that Yale was the perfect place to do all of that.

“The whole ethos of the University, and the cross-disciplinary learning that happens between the schools and the departments, meant there was enough flexibility in the curriculum to be able to prepare myself for those non-traditional paths,” she said.

After graduation Etiebet completed her internal medicine residency at Cornell, infectious disease fellowship at Columbia, and then joined the faculty at the University of Maryland, where she worked on their PEPFAR HIV/AIDS program in Nigeria. During her time there, she contributed to health care policy and health system-strengthening efforts, and saw firsthand the positive effects of integrating the clinical public health and public policy arenas.

Merck for Mothers offered Etiebet the perfect opportunity to put to use skills she had accrued over the years. “It brought together my international experience, my U.S.-based experience, and the research I’d done,” she said. “More importantly, it allowed me to think about how to harness the role of the private sector to advance innovation and bring diverse stakeholders to this issue—space.”

At Merck, Etiebet manages a core team of 12 people, access to experts across the Merck enterprise with whom she can consult with for different projects. Merck for Mothers currently has active projects in 48 countries, with a focus on four countries with high rates of preventable maternal deaths: Nigeria, India, Kenya, and the United States.

It often surprises people that maternal mortality is on the rise in the U.S., Etiebet said, particularly since global rates are declining. For many years, the U.S. did not closely track its number of preventable deaths, and thus researchers did not understand why women were dying during pregnancy and childbirth. Data collected by the CDC through the support of Merck for Mothers found that over 60% of maternal deaths for American women are preventable.

“Once data became available, we saw that our rates are actually getting worse, not better, and we’re seeing increased disparities between Black and White women,” Etiebet said.

Black women are, on average, three to four times more likely to die from maternal complications than White women. Maternal mortality rates highlight some of the institutionalized inequities in the U.S., Etiebet said.

That’s why in 2018, Merck for Mothers launched the Safer Childbirth Cities Initiative, which aims to support community-based organizations in cities across the U.S. with a high burden of maternal mortality and morbidity by implementing local solutions that bridge the gap between clinic and community, which helps cities become safer—and more equitable—places to give birth.

Additionally, by supporting organizations like the CDC and the Association of Maternal & Child Health Programs (AMCHP), Merck for Mothers has helped increase the number of states with official maternal death review committees to more than 40. And most importantly, Etiebet said, these states have incorporated patients’ voices into those committees, to make sure health care providers understand what happens to women before they walk into a hospital to deliver.

“To reduce preventable maternal deaths, health equity needs to be put front and center, and we believe that all the solutions that are developed and implemented should not just be informed by, but led by the women that are impacted,” Etiebet said. At the international level, Etiebet and her team work to make sure that the interventions they bring to different countries are sustainable.

“We think about the local ecosystem, and who will continue to champion and invest in this work,” Etiebet said. “We ask, ‘How can we use the local private sector to continue to advance progress?’ ”

A good example is a platform called Together for Her Health, which creates an online rating system for women in communities in India to review their maternal health care providers. The system not only informs other women about the best clinics to seek for different services, Etiebet said, it also creates an incentive for other facilities to improve their offerings so that they don’t lose patients.

“Sustainability is enabled when we create value,” Etiebet said. “If we listen to and value women and their experiences, we can reduce the number of maternal deaths.”

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