Robert Evans won the Nobel prize today for his work in developing in-vitro fertilization (IVF). The technique has now been used for 30 years to help otherwise infertile women conceive. It’s expensive, time-consuming, and it doesn’t always work. Couples routinely spend their life savings on IVF. On the other end of the technology spectrum, in both Afghanistan and Niger, a pregnant woman stands a 1 in 55 chance of dying as a result. And women have babies anyway — wanted babies that they conceive on purpose.

Villager women in the developing world and wealthy women using high-tech approaches have one powerful thing in common. They want to be pregnant, and they want it badly enough to risk important resources – their health, their livelihoods, and their savings. And they do know the risks. Women undergoing IVF are bombarded with data on their risks and costs. Women in high maternal mortality countries see their friends and relatives die in childbirth.

The human desire to reproduce is powerful. We’ve done service to it at the top of the pyramid; assisted reproduction technology has exploded in the last 50 years. The question is, what do we do for the bottom of the pyramid? How do we trigger the same kind of revolution? My best guess: we need two things. Better data and more money.

We have identified a lot of ways to make motherhood safer for individual women. What we don’t have is data on how to best make sure those interventions get to women. So we need better information on how to reach women, especially women in countries with weak health systems. Because having lots of great technology and methods is worthless is we can’t find a way to get them to the women who need them.

And then, of course, we need money. Lots of money. Ban Ki Moon launched a global strategy on women’s and children’s health twelve days ago. It has 40 billion dollars of pledged funding behind it. Oxfam estimates we’ll need double that. I can’t find a cost breakdown on the maternal health portion of the strategy, but nonetheless – we’re talking big numbers. Big estimated numbers, at present – we can’t spend that big money usefully without data on the best way to do it.

But how do we get the data and the money we need to revolutionize maternal health at the bottom of the pyramid like we did at the top? I’ve got a few guesses, but none of them are very good. The private sector is good at delivering inexpensive low-tech fixes for improving maternal mortality – things like birth kits. The public sector is good, theoretically, at addressing systemic problems. And we’ve seen some successes: Rwanda, for example, has reduced maternal mortality by getting more women to give birth with skilled attendants. Egypt has brought it down through improving access to contraception.

There must be a way to make this happen everywhere. We just have to find it.

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