1. SPECIAL REPORT:
HELPING MOMS
IN THE U.S. AND
AROUND
THE WORLD
WHY WE ALL SHOULD BE
INVESTING in
MOTHERS
p/2
+ INNOVATION // BRINGING
DEFINITION TO THE PROBLEM
OF FISTULA
p/5
TAKE THE
MATERNAL HEALTH QUIZ
p/7
DIRECT Mother and baby
RELIEF.
receive care at
Sumbawanga District
Photo credit goes here
Hospital in western
ORG
Tanzania.
THIS REPORT WAS PAID FOR BY A GENEROUS BEQUEST

2. WE MOTHERS
PHOTO: ONE HEART WORLD-WIDE
MOTHERS ARE CRITICAL TO THE HEALTH OF FAMILIES, communities, economies, and humanity itself.
That’s why it’s staggering that a woman dies every 90 seconds from complications during pregnancy
or childbirth—more than 350,000 women each year worldwide. Pregnancy is often a time of joy and
»
trepidation, but in developing countries, it is a life-threatening condition, as pregnancy and childbirth are
the second leading cause of death among women of reproductive age.
Many of the risks for expectant mothers in developing countries are related to general conditions
of poverty, nutrition, and severely limited health resources and access. That’s why Direct Relief’s
humanitarian health efforts place particular emphasis on protecting women through the critical periods
4
of pregnancy and childbirth.
HERE ARE
SMART INVESTMENTS
IN SAFE MOTHERHOOD
WE CAN ALL GET BEHIND
2 DIRECTRELIEF.ORG SPRING 2012

3. 1
SUPPORTING MIDWIVES
THE BEST WAY TO KEEP
MOTHERS SAFE in developing
countries—where 99% of maternal
deaths occur—is to make sure every
birth is accompanied by a trained and
equipped professional. Midwives are
the first line of assistance, managing
the health needs of mothers and
newborns during pregnancy, delivery,
and beyond. A well-trained midwife
can provide high-quality care during
PHOTO: LINDSEY POLLACZEK
routine deliveries, manage basic
complications, and recognize when
to refer a mother to higher-level
emergency obstetric care.
EQUIPPING THE NEXT
GENERATION OF MIDWIVES
IN SIERRA LEONE
IN 2012, DIRECT RELIEF School of Midwifery, Makeni
WILL ENABLE
SIERRA LEONE IS ONE OF THE MOST DANGEROUS PLACES IN THE
1O,OOO SAFE BIRTHS
WORLD TO BE A MOTHER. In 2011, it was listed 12th from the bottom
on the Mothers' Index, which analyzes health, education, and economic
conditions for women and children in 164 countries.
BY EQUIPPING 200 MIDWIVES IN Conditions for mothers and their children are grim in Sierra Leone.
The lifetime risk of a woman dying from pregnancy-related causes
SIERRA LEONE, SOMALILAND, is one in 21, largely due to the fact that only 42 percent of births are
assisted by a skilled birth attendant.
UGANDA, AND NEPAL. Fortunately, programs are in place and underway to help train
more skilled health providers who can change what it means to be a
mom in Sierra Leone.
April 22, 2012 was graduation day for the first class of 69 midwives
from the School of Midwifery in Makeni, Sierra Leone. Direct Relief has
been working with the school in partnership with Medical Research
Centre, a local organization focused on improving maternal and
child health care at rural government health centers. The School of
Midwifery at Makeni is only the second school in the country to provide
midwife training. Equipped with new midwife kits from Direct Relief,
the new midwives will play a pivotal role combating some of the
highest maternal mortality rates in the world.
ABOVE:
Graduating midwives at the School of
Midwifery in Makeni, Sierra Leone.
LEFT:
A midwife examines an expectant mother
at Xela Aid Clinic in San Martin Chiquito,
Quetzaltenango, Guatemala.
PHOTO: DAN SMITH
SPRING 2012 DIRECTRELIEF.ORG 3

4. 2
PROTECTING
MOTHERS
WHEN
SOMETHING
GOES WRONG
PHOTO: LIBA TAYLOR, WWW.LIBATAYLOR.EU
ABOVE:
Mother and baby receive care at the IN 15 PERCENT OF DELIVERIES WORLDWIDE, COMPLICATIONS WILL
Direct Relief-supported Edna Adan
University Hospital in Hargeisa, ARISE. WHEN THIS HAPPENS, IT IS ESSENTIAL THAT MOTHERS HAVE
Somaliland.
ACCESS TO LIFE-SAVING EMERGENCY OBSTETRIC CARE, INCLUDING
A CESAREAN SECTION. SUCCESSFUL EMERGENCY OBSTETRIC CARE
BELOW:
Mother and baby receive care
REQUIRES THREE THINGS:
at Leogane, Haiti’s Polyclinique
Camejo—one of 115 Haitian ›› rained providers who know how to manage­­
T —and when to refer—emergency cases;
health facilities to whom
Direct Relief has provided ›› vailability of the proper equipment and supplies to manage such cases; and
A
1,000 tons, $70 million in
life-saving medicines and ›› functioning referral system that can move a mother quickly to the appropriate level of care.
A
medical supplies since the
2010 earthquake.
IN HAITI, IN UGANDA,
Direct Relief is increasing the emergency where 16 women die in childbirth every day,
obstetric care capabilities of 8
HOSPITALS Direct Relief fully equipped the new operating
that will serve 60,000 MOTHERS over the theater at RUGARAMA HOSPITAL in Kabale. Prior
next three years. Direct Relief provided exam to Direct Relief’s investment, there was only one
tables, operating tables, sterilizers, instruments, operating theater to provide emergency cesarean
baby monitors, scales, IV stands, exam lights, sections for the entire district of 600,000 people.
PHOTO: ANDREW MACCALLA
ventilators, ultrasounds, and hundreds of In the first six months after the theater opened,
incentive kits to encourage more women to the hospital averaged 40
DELIVERIES PER MONTH,
deliver at the facilities.
INCLUDING 15 CESAREAN SECTIONS, AND NO
MATERNAL DEATHS.
4 DIRECTRELIEF.ORG SPRING 2012

5. VIEW THE GLOBAL FISTULA CARE MAP AT GLOBALFISTULAMAP.ORG
RESTORING
THE HEALTH
OF INJURED MOTHERS
PHOTO: LINDSEY POLLACZEK
DEFINING THE LANDSCAPE OF FISTULA CARE
Q/A AN ESTIMATED TWO MILLION WOMEN worldwide are suffering
from a condition few people know about. The condition is
DIRECT RELIEF
WHAT IS FISTULA?
obstetric fistula, and it is entirely preventable and treatable. FISTULA CARE SUPPORT
A hole in the birth canal
caused by prolonged and Direct Relief, in partnership with the UNFPA and The Fistula
obstrutcted labor. Foundation, developed the Global Fistula Care Map—the first- Medical and surgical
WHY DOES IT MATTER? ever worldwide map of this devastating childbirth injury—to help supplies to 11 facilities in 8
Fistula causes chronic
better understand the current fistula treatment capacity to more countries providing fistula
incontinence and can lead to repair to approximately
severe medical problems and effectively target scarce resources to where they are needed most,
social ostracization.
3,000 women each year
and identify where gaps in service may exist.
WHOM DOES IT AFFECT?
THE GOAL IS TO ENSURE EVERY WOMAN $1.3 million in medical
Impoverished women in remote
areas, far from medical care. WITH OBSTETRIC FISTULA RECEIVES A LIFE- resources from leading
WHAT CAN BE DONE? RESTORING SURGERY AND THAT ALL FUTURE healthcare companies
The number of women with
CASES ARE PREVENTED. UNDERSTANDING such as Johnson
fistula far surpasses the global
Johnson, Ethicon,
capacity for treatment, but fistula WHERE THE PROBLEM IS AND WHERE TREAT-
can be prevented when women Covidien, BD, CR Bard,
have access to a skilled attendant
MENT IS AVAILABLE TODAY ARE ESSENTIAL Hospira, and Henry
during childbirth. Reconstructive STEPS TOWARDS THAT GOAL. Schein, to help fistula
fistula repair surgery can also be
surgeons treat women
provided by a trained surgeon.
in need
With private foundations
« MEET SELFA… such as The Fistula
Just outside Mumias, Kenya, Foundation, established
Habiba Mohammed (right) works
a surgical theater in
to identify, refer, and support
women like Selfa (left) who Somaliland for fistula
require treatment for obstetric treatment, and trained
fistula. Habiba referred Selfa to health providers in Western
life-restoring surgery after Selfa
Kenya in fistula care
suffered from incontinence due to
fistula for eight years. Now free of
fistula, Selfa is happy, active, and a Supported a new fistula
new mother to a healthy baby boy, treatment facility in Danja,
earning income to support herself
Niger that will care for
and her family through poultry, fish,
and banana farming. Selfa has also 2,500 women with fistula
become an advocate, helping to and train 30 doctors in
refer another woman in her village fistula repair over the
PHOTO: LINDSEY POLLACZEK
who had suffered two decades with
next 5 years
fistula to restorative care.
SPRING 2012 DIRECTRELIEF.ORG 5

6. 4
helpiMg
n
S
MOthe
THE LARGEST
in
U.S.
CHARITABLE MEDICINES PROGRAM
SERVING LOW-INCOME AND UNINSURED
MOTHERS IN THE U.S.
DIRECT RELIEF USA STRENGTHENS THE
SAFETY NET FOR MILLIONS OF WOMEN
Direct Relief is the only nonprofit working with more than 1,000
clinics in all 50 states, providing free medications and supplies
*
for clinics’ ever-growing number of low-income and uninsured
patients.
As the first and only nonprofit licensed to distribute
pharmaceuticals in every state, Direct Relief has provided $300
million in medicines and supplies to U.S. clinics since 2004.
* 5.2 MILLION WOMEN
AGED 20-49, WERE CARED FOR AT FEDERALLY QUALIFIED
HEALTH CENTERS IN 2010, MANY OF WHICH ARE PART OF
DIRECT RELIEF’S 1,000-CLINIC STRONG NETWORK
More maternal health facts from some of Direct Relief’s
clinic-partner network:
›› 299,516 WOMEN had a mammogram
›› 1,808,992 WOMEN had a Pap test
›› 489,883 WOMEN were seen for prenatal care visits
›› 68,372 MOTHERS gave birth
(All stats, 2010 Health Resources and Service Administration Uniform Data System)
RIGHT:
Community Health and Social
Services Center, Detroit, Michigan
FAMILY PLANNING
HEALTHY SMILES Teva Pharmaceuticals provided Direct
The Healthy Smiles Dental Program
Relief with $3 million worth of the
addresses the number one unmet health
women’s health product ParaGard®,
need in Santa Barbara County—oral health.
an intrauterine copper contraceptive,
Limited access to dental treatment is
to be distributed among Direct Relief’s
widespread among low-income families.
1,000-clinic network treating low-
PHOTO: CHASS
Healthy Smiles bridges the growing gap
income and uninsured women.
of available oral health education, disease
prevention services, and treatment for low-
TRANSPARENCY income children throughout Santa Barbara
County, with 1,800 kids served since 1994.
PRECISE MAPPING OF EVERY DONATION
SENT TO EVERY CLINIC PARTNER IN THE U.S.
›› DIRECTRELIEF.ORG/USA
6 DIRECTRELIEF.ORG SPRING 2012

7. PHOTO: WILLIAM VAZQUEZ FOR ABBOTT FUND
TEST YOUR KNOWLEDGE
OF MATERNAL HEALTH ››
1// Every day, an estimated _____ women
— Charity Navigator die from preventable causes related to
pregnancy and childbirth.
a. 100
b. 500
100% EFFICIENT. c. 1,000
d. 1,500
AMONG THE 20 MOST EFFICIENT 2// ______ of all maternal deaths occur in
LARGE U.S. CHARITIES. — Forbes
developing countries.
a. 29%
b. 49%
c. 79%
d. 99%
100% OF CONTRIBUTIONS GO TO PROGRAMS. 3// Rank the following countries from
fewest to most maternal deaths.
DONATE AT DIRECTRELIEF.ORG
a. U.S., Albania, Singapore
b. Albania, Singapore, U.S.
c. Singapore, U.S., Albania
d. Albania, U.S., Singapore
4// The probability that a woman will
eventually die from a maternal cause is 1 in
____ in developed countries, versus 1 in ____
in developing countries.
a. 4,300; 120
b. 2,000; 300
2011 PETER F. DRUCKER AWARD c. 1,700; 460
d. 1,100; 500
WINNER FOR NONPROFIT INNOVATION 5// In high-income countries, virtually all
women are attended by a trained health
rick wartzman, Drucker Institute Executive Director: professional during childbirth. ____ of
women in low-income countries are not
“[Direct Relief’s] fundamental insight—to take the best in private- assisted by a doctor, nurse, or midwife
during childbirth.
sector technology and uniquely adapt it for the social sector—has
a. 30%
greatly strengthened a weak link in the medical supply chain…Its
b. 40%
efforts demonstrate that social-sector organizations can achieve the
c. 50%
very highest levels of efficiency. ” d. 60%
5. d (All stats, WHO) 4. a 3.b 2. d 1. c
SPRING 2012 DIRECTRELIEF.ORG 7

8. Leave a Legacy
A bequest or planned gift to Direct Relief can extend your generosity beyond your lifetime. Your commitment and
dedication will help people in the U.S. and around the world affected by poverty, disaster, and civil unrest live better,
healthier lives far into the future. With such a gift, you will be included in the Legacy Society, which recognizes
visionary and caring individuals who have included Direct Relief in their estate plans.
For more information on planned giving, visit DirectRelief.GiftLegacy.com, or contact
Jonathan Glasoe, at JGlasoe@DirectRelief.org or (805) 879-4936.
LEGACY SOCIETY MEMBERS
Anner Trust Marjorie B. Cullman Trust Ed Mary Harvey Trust Estate of Yvonne C. Lucassen William J. Partridge Revocable Estate of Robert H. Sommer
Dotsy Jack Adams Roy R. Laurie M. Cummins Fund Mrs. Raye Haskell Evelyn C. Lund Charitable Living Trust Estate of K. Walter Stawicki
Ms. Jane H. Alexander Estate of Margaret E. Davis Betty Stan Hatch Remainder Trust Jody Don Petersen Estate of Elaine F. Stepanek
Anonymous Estate of Peter M. Dearden Estate of Dorothy S. Hitchcock Estate of Robert Maclean Martin and Lillian Platsko Trust Walter Mae Stern Trust
Estate of Rhea Applewhite Estate of H. Guy Di Stefano Terrence Joseph Hughes Marilyn Frank* Magid Mr. Juan Posada The Anna Stuurmans Revocable Trust
Dr. Mrs. Gilbert L. Ashor The Grant C. Ehrlich Trust Estate of Dorothy Humiston Audrey E. Martinson Estate of Nancy Roberts Estate of Elna Theusen
Miriam William* Bailey Mr. and Mrs. Edward G. Ewing Pat Dick Johnson Martone Family Trust Estate of Paul N. Roberts Estate of Wilbur H. Thies, Sr.
The Charles H. Bell Charitable Estate of Elsie Feibes Ms. Beverly A. Jones Kathleen Bruce McBroom Estate of Maria Rosmann and Emily P. Thies
Remainder Trust Estate of Florence Feiler Estate of Judith Jones Ms. Estelle Meadoff The Babette L. Roth Estate of Grace A. Tickner
Merle E. Betz, Jr. Estate of Howard C. Fenton Mrs. Marvel Kirby Mr. Michael Mendelson Irrevocable Trust Tilton Family Foundation
Estate of D. Craig Bigelow Peggy Gary Finefrock John and Sandy Knox-Johnson Mr. Mrs. Frank B. Miles Mr. and Mrs. Ernest J. Salomon Donn V. Tognazzini
Mr. Joseph F. Bleckel Estate of June Breton Fisher John Michael Koelsch Patricia McNulty Mitchell Maryan Richard Schall Carol Van den Assem Trust
Mrs. Helen J. Brown Mr. and Mrs. Gregg L. Foster Mr. James Kohn Charles J. and Esther R. Mlynek Trust The Petar Schepanovich* Estate of Marie L. Van Schie
Estate of Marguerite Bulf Estate of Mario J. Frosali Anette La Hough Irrevocable Trust Estate of Velma Morrell Kathleen Schepanovich Trust Bettine* Lawrence Wallin
Don Bullick Mildred K. Fusco Trust Dorothy Largay Wayne Rosing Helga Angenendt Morris Nancy Bill* Schlosser Simone G. Woodcock
William S. Burtness Estate of Hannah Monica Gallagher Estate of Lensch Family Estate of Regis J. Morris Estate of June H. Schuerch Linda Seltzer Yawitz
Ms. Carol Carson Sandra K. Garcia Kenneth R. Loh Rita Moya Harold Carol M. Shrout Marjorie Lynn Zinner
Estate of Charlotte Castalde Estate of June Gaudy Estate of Barbara Jeanne Lotz Estate of Dorothy and Graham Nash Connie Smith Nevins
Ms. Patricia Clancy Ms. Inez M. Gilkeson Lawrence Lu Estate of James Orr Estate of Margaret H. Smith * deceased
The Crosby Fund Kate Dick Godfrey Estate of Harold A. Parma Estate of Thelma R. Smith
NONPROFIT ORGANIZATION
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ww w .D i r e ct R e l i e f . o rg
BOARD OF DIRECTORS
CHAIR Thomas J. Cusack
VICE CHAIR John Romo
SECRETARY Rita Moya
TREASURER Patrick Enthoven
Kendall Bishop • Jon E. Clark • Lawrence Dam • Patty DeDominic
Hon. Paul G. Flynn • Gregg L. Foster • Dorothy Gardner • Ernest J. Getto
J. Michael Giles • Bert Green, M.D. • Raye Haskell • W. Scott Hedrick
Priscilla Higgins, Ph.D. • Angel Iscovich, M.D. • Ellen K. Johnson
Nancy Walker Koppelman • Donald J. Lewis • Mari Mitchel • Jeanne Newman
Mary Louise Scully, M.D. • James Selbert •Ayesha Shaikh, M.D.
George Short • Gary R. Tobey
INTERNATIONAL ADVISORY BOARD CHAIR EMERITI
Lawrence R. Glenn • E. Carmack Holmes, M.D. Richard Godfrey
S. Roger Horchow • Stanley S. Hubbard • Jon B. Lovelace Stanley C. Hatch
Donald E. Petersen • Richard L. Schall • John W. Sweetland Dorothy F. Largay, Ph.D.
Denis Sanan
HONORARY BOARD Nancy Schlosser
PRESIDENT EMERITUS Sylvia Karczag
CHAIR EMERITUS Jean Hay
DIRECTOR EMERITUS Dorothy Adams
PRESIDENT CEO Thomas Tighe
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8 DIRECTRELIEF.ORG SPRING 2012