1. © GIRHL 2016
Who We Are
According to the World Health Organization (WHO), two-thirds of preventable maternal deaths occur in
developing countries, with nearly half occurring in sub-Saharan Africa. In Sub-Saharan Africa, a mother's risk of
dying in childbirth is 1 in 38, 10 times higher than in developed countries. Similarly, risks to the fetus are also
significantly higher in developing countries, which account for 98% of all stillbirths. Many of the causes of
maternal and fetal death are preventable. GIRHL wishes to address the core causes of these rates of morbidity
and mortality.
GIRHL values the beliefs that a healthy family is the foundation for a stronger community and the cornerstone of a
better society, and that innovation and sustainability are the key drivers of improvements in global health. We
envision a world where all women and men have access to quality reproductive healthcare regardless of
socioeconomic status, religion, ethnicity, or geography.
Our Mission
To identify problems through an engineering lens and increase access and quality of reproductive health care
globally through research, development, and implementation of innovative solutions.
Vision
A world where all women and men have access to basic reproductive health care regardless of geography,
economic status, religion, or ethnicity.
What We Do
 We connect local healthcare workers with our interdisciplinary team of engineers, clinicians, researchers, and
entrepreneurs to identify problems.
 We conduct research to gain new insight into the problem.
 We utilize research insights to brainstorm and develop innovative solutions that effectively address the
problem.
 We strategically seek solutions that generate the highest return per dollar invested.
 We test and implement solutions and disseminate findings to the global community.
Developed countries have access to modern reproductive healthcare resources such as birth control, surgical
intervention, and prenatal care. However, access to these services is made possible by infrastructure that
requires decades for countries to develop as well as political and economic stability. Therefore, we must innovate
to meet reproductive health needs on a global scale. At GIRHL, we utilize a scientific approach from an
engineering perspective to foster innovation.
Our programs are designed address two large but key areas of unmet need in developing countries-- obstetric
fistula and maternal health. A brief overview of our programs is highlighted below.
GIRHL’s mission is to increase access and quality of reproductive health care globally through research,
development, and implementation of innovative solutions.
development, and implementation of innovative solutions..

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Obstetric Fistula Programs
Background:
A complication of prolonged labor is that pressure of the fetal head on pelvic organs can lead to significant tissue
damage (similar to a pressure sore) and result in an obstetric fistula (OF), a large hole between the vagina and
bladder or rectum, which leads to unremitting urinary and often times fecal incontinence. According to the UN
Population Fund, there are approximately 2 million women around the world living with OF, with 50,000 to
100,000 new cases every year. Although the hole, or fistula, can be closed surgically, only about 15,000 surgeries
are performed worldwide each year, and the majority of women lack access to these surgeries. Nonetheless, in
those who make the long journey to a surgery center, up to 50% of them remain incontinent even after the fistula
has been closed, and therefore they continue to suffer the physical and social consequences of OF.
The work of our obstetric fistula innovation programs is primarily conducted at the Addis Ababa Fistula Hospital
(AAFH), a unique 120-bed hospital dedicated to treating obstetric fistula patients managed by Hamlin Fistula
Ethiopia (a charitable organization registered in Addis Ababa, Ethiopia). Together with its 5 satellite regional
centers, AAFH is the largest facility in the world devoted exclusively to fistula care, treating over 2,500 patients
annually.
Problems Addressed:
 Poor surgical outcomes
 Lack of conservative treatment options for those without access to surgery
 High incidence of iatrogenic vesicovaginal fistula
Our Innovations:
Development and implementation of culturally-compliant methods for evaluation of lower urinary tract
function
Study Site: Addis Ababa Hospital, Addis Ababa, Ethiopia; Panzi Hospital, Bukavu, eastern Democratic Republic
of Congo
For the past several years, we have been working with the Addis Ababa Fistula Hospital (AAFH) in Addis Ababa,
Ethiopia to improve the care of patients with obstetric fistula. Through collaboration with local care providers, we
have designed and implemented novel medical equipment for patients at the hospital, and developed a series of
innovative evaluation techniques for patients that continue to suffer from incontinence after fistula closure. These
techniques, which aim to more comprehensively evaluate each patient, have since been adopted as standard of
care at AAFH. We are currently working to disseminate our findings in the medical literature as well as begin
implementing these techniques throughout the continent starting with the Panzi Hospital, Bukavu, eastern
Democratic Republic of Congo.
Development of a low-cost, durable device for managing incontinence in the over 2 million women who
lack access to surgery
Study Site: Addis Ababa Hospital, Addis Ababa, Ethiopia
Through a partnership with Omni Medical Systems (OMS), a research and development firm that designs and
manufactures in-flight bladder relief devices for NASA and the US military, we are working to develop a low-cost,
culturally-acceptable urine management device. This device is not designed to replace surgical treatment, but
instead designed to provide a means of managing the devastating consequences of obstetric fistula in the millions
of women who lack access to surgery, thereby helping patients circumvent the social and psychological
implications of living with fistula.
Research into the epidemiology of iatrogenic vesicovaginal fistula in developing countries
Study Site: International collaboration with Dr. Thomas Raassen, Nairobi, Kenya
Clinicians working with patients, who have suffered obstetric fistula are noticing an alarming trend in increasing
number of Cesarean sections (CS) performed in patients with stillbirths. Often times, these patients have been in

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labor for 3 or more days prior to CS. In addition to nearly 4 times increased likelihood for maternal death following
CS compared to vaginal delivery, it has been shown that up to 13% of fistulas are iatrogenic in nature (i.e.
inadvertent fistula resulting from provider error during CS surgery). In 2015, we began a collaboration with Dr.
Thomas Raassen, a world-renowned fistula surgeon based in Nairobi, Kenya, to collect and analyze the data
necessary to better understand the epidemiology of iatrogenic fistula in developing countries. Through this
research, we aim to educate local communities throughout the African continent and provide data-driven policy
recommendation for reducing the rates of unwarranted CS.
Maternal Health Programs
Background:
The World Health Organization report the global prevalence of stillbirths to be 2.6 million, of which 98%
occur in developing countries. Sub-Saharan Africa has the highest rate of stillbirth worldwide and has made the
least progress in stillbirth reduction. Like stillbirth, low-birthweight (defined as weighing <2500g or 5.5lbs at birth)
remains a significant global health challenge. Not only is low-birthweight a known contributor to stillbirth, but
infants with low-birthweight are nearly 20 times more likely to die than heavier babies. Each year, there are over
20 million infants born with low-birthweight, of which 96% occur in developing countries. In addition to stillbirth and
low-birthweight, maternal mortality is socially devastating problem that continues to plague many developing
countries. In Sub-Saharan Africa, a mother's risk of dying in childbirth is 1 in 38—nearly ten times higher than in
developed countries, which have access to modern health care resources such as birth control, surgical
intervention, antibiotics, and prenatal care. Maternal/neonatal morbidity and mortality, along with empowering
women in all ways, has a ripple effect through the family and the community, even whole countries. Healthy
mothers create better outcomes for the newborn babies, resulting in a healthier population. Even older children
become vulnerable when orphaned. One healthy generation is more likely to beget another healthy generation.
The work of our maternal health innovation programs is primarily conducted at the Korle Bu Teaching
Hospital (KBTH), in Accra, Ghana. The KBTH is the third largest hospital in continental Africa. Over 11,000
babies are born at KBTH yearly (about 31 babies per day). Our Ghanaian team is world class and consists of 2
OBGYNs, 3 midwives, and 1 biostatistician. More recently, we have solidified our long-term collaboration by
entering into an exclusive partnership with KBTH to conduct robust, innovative maternal health research that can
be easily translated into patient care and implemented throughout hospitals in West Africa.
Problems Addressed:
 High rates of stillbirth and low-birthweight
 High rates of maternal death due to pre-eclampsia
 Lack of life-saving maternal fetal monitoring systems
Our Innovations:
Development and assessment of a novel device for the prevention of stillbirth and low-birthweight: the
Prenabelt
Study Site: Korle Bu Teaching Hospital, Accra, Ghana; IWK Health Centre, Halifax, Canada; University of South
Australia, Adelaide, Australia
There has been little evidence of the effect of lying on one’s back during sleep in pregnancy. Recently, three
studies have suggested that sleeping on one’s back in late pregnancy may be a risk factor for stillbirth and low
birth weight. This is significant given that the majority of pregnant women spend up to 25% of their sleep time on
their back in late pregnancy. In 2014, our team won a $100,000 CAD award from Grand Challenges Canada and
a $25,000 AUD award from the University of South Australia to investigate a novel approach to reduce the rates
of stillbirth and low birth weight. We have developed a device, called PrenaBelt, to reduce the amount of time a
pregnant woman spends on her back while sleeping. Currently, we are conducting three trials – one in each
Australia, Ghana, and Canada – to investigate the effect of the PrenaBelt on the mother’s sleep and her baby’s

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birth weight. Recruitment of participants is 100% complete in Australia, 95% complete in Ghana, and just getting
started in Canada. We are particularly excited about our progress in Ghana, where we are conducting a double-
blind, sham-controlled randomized trial.
Link between semen exposure and pre-eclampsia in African populations
Study Site: Korle Bu Teaching Hospital, Accra, Ghana
Preeclampsia is one of the predominant contributors of maternal death worldwide, with a higher incidence in
developing countries. Because the etiology of preeclampsia is unknown, there is currently no cure available for
mothers diagnosed with this condition, other than emergent delivery of the baby. Previous studies in developed
countries have shown an association between decreased paternal semen exposure and increased risk of pre-
eclampsia. However, such associations have not previously been assessed in African populations. Given the
potential for development of preventive strategies, we are beginning a first-of-its-kind project aimed at studying
the link between paternal semen exposure and pre-eclampsia in Ghana. We will utilize the insights gained
through this research to develop low-cost and scalable prevention strategies, which will be subject to the rigor of
randomized controlled trials, with the ultimate goal of reducing the rates of pre-eclampsia and maternal death at a
population level.
Development and implementation of novel maternal-fetal monitoring systems designed for low-resourced
settings
Study Site: Korle Bu Teaching Hospital, Accra, Ghana
Clinicians in developed countries have access to a wide range of clinical techniques and investigations to survey
the condition of a fetus in the womb as well as obtain real-time vital signs of the mother. These maternal-fetal
monitoring systems are often deployed during labor to monitor both fetal and maternal well-being. However, most
clinicians in developing countries lack access to such systems, and do not have the resources necessary to
implement currently available systems, which are bulky and require network infrastructure as well as
maintenance. We are work with KBTH, through an exclusive partnership, to develop a plan for effective design,
testing, and implementation of an innovative, wireless, low-cost maternal-fetal monitoring system, which can be
implemented across various settings throughout the African continent. By working in partnership with key medical
device companies, we plan to develop a sustainable solution which promises to reduce the burden of
maternal/neonatal mortality and morbidity in low-resource settings.
Where to go for More Information:
www.girhl.org
Please email us directly at info@girhl.org
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