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Learning from Failure to Reduce Maternal Deaths

October 12, 2015

This past May, I attended an impressive TEDWomen conference, and I’ve had TED talks on my mind ever since. Their candor. Their insight. Their willingness to push the boundaries of imagination and what’s possible. But I’ve also noticed a trend among these talks that’s particularly appealing: their willingness to take on the traditionally embarrassing subject of failure.

It turns out that if you search the word “failure” on, you’ll uncover hundreds of talks and blogs about this often taboo topic that’s now been embraced by leaders in fields ranging from technology to science to economics to art and many in between. It’s refreshing to hear some of the world’s luminaries suggest that it wasn’t some special talent or gift that helped them achieve great success, but rather the lessons they’ve gleaned from failing – over and over.

A great story about failure is one that Paul Allen, the Microsoft co-founder, tells. Early in his career, he and his partner, Bill Gates, were forced to shut down operations of their traffic-flow data analysis company because they never did the research that would have shown how challenging it is to get municipalities to commit resources to the kind of product they developed. Allen has since acknowledged the importance of this experience: “Traf-O-Data remains my favorite mistake because it confirmed to me that every failure contains the seeds of your next success.”

As an Ob/Gyn and women’s health advocate, I couldn’t help but make the connection between learning from failure and the global push to end preventable maternal deaths. While our collective efforts certainly have not failed – we’ve managed to cut maternal mortality in half since 1990 – progress has been slower than it should be. So in some respects, we’ve failed the nearly 300,000 women who die during pregnancy and childbirth each year, and the millions of families and communities affected by these preventable deaths.

To be sure, when the stakes are as high as life and death, it is particularly difficult to admit failure. But in these situations, I believe it’s even more important to examine and learn from what went wrong.

My colleagues and I at Merck for Mothers have embraced the idea of learning from failure in our global effort to help save women’s lives from pregnancy and childbirth complications. Taking a page from the pharmaceutical industry, which is known for “failing fast and failing smart” when it comes to product development, we’ve built our initiative to operate like a living laboratory. We’re comfortable designing high-risk solutions to improve maternal health, testing them and valuing what we learn, rather than being afraid of failing. We view the risk of failure not as a bad thing, but as an alternative outcome that comes with investing in innovation.

One of these “fail fast, fail smart” solutions involved enlisting drug shop owners in Uganda to promote the importance of women giving birth in a health facility, rather than at home. Drug shops are often the first source of health services for women in many communities, and our plan was to train the drug shop employees to counsel pregnant women on the importance of going to a clinic or hospital to give birth, and refer them to nearby health facilities. It took only a few months for us to realize that this approach was not working. These poorly paid attendants change jobs often, requiring frequent training, which is expensive, and they make their money from selling products, not counseling clients, so there was no incentive to take on this new responsibility.

After hearing from the attendants themselves and putting our heads together with our local partners, we discovered that leveraging what the drug shop attendants do best – selling products – could be the key to success. So we changed course. Today, we’re working with the drug shops to sell clean delivery kits, which women need when they go to a health facility to give birth. The kits are affordable and, thus, an attractive product for drug shops to sell and women to buy. Now drug shop attendants have an incentive to speak with pregnant women about delivering in a facility.

This is just one small example of how studying failure and understanding why a seemingly good idea doesn’t work helps us design a better intervention the next time around.

That’s why I am looking forward to talking more about how we can all learn from failure during a special session called "FAIL: First Attempt at Learning" during next week’s Global Maternal and Newborn Health Conference in Mexico City, where maternal health experts will come together to look back on our progress and focus on what we need to do to end preventable maternal and newborn deaths in the future.

As I’ve learned over the years – whether from a TED talk or my own experience in maternal health – it’s human to make a mistake, but it’s foolish – and in this case, fatal – not to learn from it.

BIO NOTE: Merck for Mothers is Merck's 10-year, $500 million initiative that applies the company's scientific and business expertise – as well as its financial resources and experience in taking on tough global healthcare challenges – to reduce preventable maternal mortality worldwide. 

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