Giving birth safely is a privilege of the rich

EVERY year, 536,000 women and girls die as a result of complications during pregnancy, childbirth or the six weeks following delivery.

Almost all of these deaths (99 percent) occur in poor countries.

Maternal mortality is among the health indicators that show the greatest gap between the rich and the poor—both between countries and within them.

Developed regions report nine maternal deaths per 100,000 live births compared to 450 maternal deaths in developing regions, where 14 countries have maternal mortality ratios of at least 1,000 per 100,000 live births.

The aim of the Millennium Development Goal is to reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. Overall, the target is to achieve, by 2015, universal access to reproductive health.

The available trend data indicate that there has been little progress: 480 maternal deaths per 100,000 births in 1990 compared to 450 deaths in 2005.

Obstetric complications—including post-partum hemorrhage, infections, eclampsia, and prolonged or obstructed labor—and complications of unsafe abortion account for the majority of maternal deaths.

Anemia, exacerbated by malaria, HIV and other conditions, heightens the risk of maternal death from hemorrhage.

Yet most of these conditions could be prevented or treated with good quality reproductive health services, antenatal care, skilled health workers assisting at birth, and access to emergency obstetric care.

Since 1995, every region of the developing world has made some progress in improving the availability of skilled health personnel (doctors, nurses or midwives) to assist in deliveries.

Overall, the proportion of births attended by skilled health workers in developing regions has increased from 53 percent in 1990 to 61 percent in 2007. However, in Southern Asia and sub-Saharan Africa, more than half of all births still take place without the assistance of trained personnel.

Ready access to emergency obstetric care is crucial to ensure that a higher level of care can be provided in a timely manner when life-threatening complications arise.

Many health problems among pregnant women are preventable, detectable or treatable through visits with trained health workers before birth. The UN Children’s Fund (Unicef) and the World Health Organization (WHO) recommend a minimum of four antenatal visits.

These enable women to receive important services, such as tetanus vaccinations and screening and treatment for infections, as well as potentially life-saving information on warning signs during pregnancy.

Since the 1990s, the proportion of pregnant women in the developing world who had at least one antenatal care visit increased from around 64 percent to 79 percent. However, a substantially lower proportion of pregnant women receive the standard set of four visits recommended by WHO and Unicef.

The risks are high for both mother and child when pregnancy occurs at too young an age. Young adolescents are more likely to die or experience complications in pregnancy and childbirth than adult women.

Moreover, the children of these young mothers have a higher risk of diseases and deaths. Girls who give birth before the age of 15 are five times more likely to die in childbirth than women in their twenties.

Pregnancy early in life contributes to the estimated 70,000 maternal deaths among girls’ ages 15 to 19 years old every year.

An infant’s risk of dying in his or her first year of life is 60-percent higher when the mother is under age 18 than when the mother is 18 or older. The adolescent birth rate is the number of births per 1,000 women ages 15 to 19 years old.

This age range includes not only young adolescents but also women ages 18 and over who experience lower morbidity and mortality risks during pregnancy and childbirth than their younger counterparts.

The Millennium Development Goals Report 2009