Maternal and Child Health

Pregnancy and childbirth can be extremely dangerous. Every minute, a woman dies from complications of pregnancy and childbirth somewhere in the world at least 530,000 deaths per year.1 For each one who dies, another 30 to 50 suffer debilitating injury, infection or disease. Maternal mortality shows the huge disparity between rich and poor countries: 99 percent of maternal deaths occur in the developing world. In sub-Saharan Africa, one woman in 16 dies from pregnancy or childbirth, but only one woman in 4,000 dies in western Europe.2 Most of these casualties could be prevented if women had access to basic medical care during pregnancy, childbirth and the postpartum period. The Situation In developed countries, one woman in 2,800 dies from complications of pregnancy and childbirth. In developing countries, one woman in 67 dies. 1 In Sweden, the country with the lowest risk, one woman in 29,800 dies from complications of pregnancy and childbirth. At the other end of the scale are Sierra Leone and Afghanistan, where death comes in pregnancy or childbirth for one woman in six. 1 Teenage girls over 15 years of age are twice as likely to die from childbirth as are women in their 20s, while girls under 15 face five times greater risk. 3 The poor health of mothers is a major cause of newborn deaths: 98 percent of the worlds 4 million stillborn babies every year are in developing countries; another 4 million die before age one month. 4 At least 35 percent of women in developing countries receive no prenatal care. Almost half give birth without skilled attendance (doctor, nurse or trained midwife), and 70 percent receive no care in the six weeks after delivery. 5 Obstructed labor, common worldwide, is treated in developed countries by Caesarean section. Where emergency care is not available, the mother and child usually die. If the woman survives, she may incur an obstetric fistula, an opening between the vagina and rectum or bladder. The result is unrelenting incontinence, which leads to odor, infections and social ostracism. One million children die each year because their mother has died. The risk of death for children under 5 doubles if their mothers die in childbirth. 2 More than one-third of all pregnancies worldwide are unwanted. Each year, some 20 million unsafe abortions are performed, killing nearly 78,000 women and disabling hundreds of thousands more.4 A quarter of all unsafe abortionssome 5 millionare performed on adolescent girls aged 15-19. 4

Current funding is sufficient to provide only one-eighth of the reproductive health supplies the world needs now, including maternal and neonatal health care commodities.6 Up to a third of maternal mortality and morbidity could be avoided if women had access to information and a full range of modern, safe and effective family planning methods.7 One in every three women worldwide has been beaten, raped, coerced into sex or physically abused in some way often by someone she knows. 5 In the United States, homicide is the top cause of death among pregnant women. 8 Low-income women are far less likely to have skilled care during childbirth. In Bolivia, 97.9 percent of births to women of the richest fifth of the population have a skilled attendant; while just 22.7 percent of the poorest women receive such care during childbirth.

Developments and Trends Since 1987, the Safe Motherhood Initiative has identified essential steps needed to reduce maternal mortality, and now emphasizes making skilled care available for each birth. Countries that provide skilled birth attendants and access to emergency obstetric care have cut their maternal deaths. Tunisia reduced its maternal mortality rate by 80 percent in 23 years with such a comprehensive strategy, and Sri Lanka reduced its maternal mortality rate from more than 1,500 per 100,000 live births in the 1960s to 30 today. 9 Women in conflict areas face especially harsh risks during pregnancy and childbirth. The number of Iraqis who die in childbirth has nearly tripled since 1989, largely because the breakdown in security, transportation and communications makes access to health facilities very difficult. About 65 percent of Iraqi women deliver at home, without skilled attendants. 10 Providing basic maternal and newborn health services to developing countries would cost an average of $3 per capita per year. 11 However, once complications develop, saving the life of a mother or infant costs about $230. The United Nations has registered more than 26 million refugees, asylum-seekers and internally displaced people worldwide, half of them girls and women. Yet less than half of the 81 non-governmental relief groups surveyed in 2000 provided comprehensive reproductive health services, offering only family planning or HIV/AIDS treatment. 12 Areas for Action Strategies to improve maternal health are well-known, but political and financial commitment to implement them is lacking. The strategies include: Delaying the age of girls sexual initiation, marriage and first childbirth and facilitating young women to have informed choices on sexuality, marriage and childbirth. Eliminating violence against women at home and in the workplace. Providing universal access to education, family planning and reproductive health services, including skilled care during childbirth. Promoting universal access to skilled care before, during and after childbirth.


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Empowering women to use available services through education, access to decision-making positions and greater access to financial resources. Addressing gender inequalities, poverty, and discrimination against women.

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WHO. Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF and UNFPA. Geneva, 2003. WHO, The World Health Report 2003, Geneva, 2003. 3 UNICEF. Innocenti Digest: Early Marriage. No. 7 (March 2001). 4 UNFPA, The State of World Population 2000: Lives Together, Worlds Apart, UNFPA, New York 2000 5 Inter-Agency Group for Safe Motherhood, The Safe Motherhood Action Agenda: Priorities for the Next Decade, Report on the Safe Motherhood Technical Consultation, Colombo, Sri Lanka, Oct. 18-23, 1997 6 The Supply Initiative, Reproductive Health Supply Shortage. http://www.rhsupplies.org/textonly/initiative/initiative_supplies.html. Accessed December 23, 2003. 7 UNFPA, Reproductive Health Essentials: Securing the Supply (New York: UNFPA, 2002). 8 Enhanced Surveillance for Pregnancy-Associated Mortality-Maryland, 1993-1998. Isabella Horon, DPH, Diana Cheng, MD of the American Medical Association, vol. 2905 issue 11 . 9 Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 2003, UNFPA and Population Reference Bureau. 10 UNFPA, Maternal Mortality Update 1998-1999, New York, February 2001. 11 UN Population Fund, Iraq Reproductive Health Assessment, New York, Aug. 3, 2003 12 Mother-Baby Package Costing Spreadsheet (unpublished). World Health Organization, Geneva, 1997. Cited in Family Care International and the Safe Motherhood Inter-Agency Group, Maternal Health: A Vital Social and Economic Investment, Fact Sheet, New York, 1998. 13 UN Population Fund, Humanitarian Response Group, Annual Progress Report 2000, UNFPA, New York, 2001