Death in Perspective

The annual death rate from maternal mortality is three times greater than the December 2004 Asian tsunami.

by Joyce Arthur

Copyright © January 2005 (revised January 2006)

(A slightly condensed version of this article was published in The Humanist magazine, Jan/Feb 2006, pp 37-38.)

In the year since the tsunami struck, the world has seen a tremendous outpouring of aid and money to the survivors in south Asia, as well as victims of Hurricane Katrina in New Orleans, Louisiana, and victims of the recent earthquake in Kashmir. 

While such disasters and resulting loss of life are extremely tragic, and the compassionate response is commendable, let's not forget that about 13 million people die every single year from causes that are often completely preventable, including over half a million women from pregnancy and childbirth complications. Of the 11 million child deaths in the world each year, almost half are related to severe or moderate malnutrition, a condition that leaves children highly susceptible to communicable diseases.Virtually all these deaths occur in poor, developing countries and are the result of ignorance and poverty.

Source:  2002 figures from the World Health Organization's The World Health Report 2004. http://www.who.int/whr/en/

These staggering numbers are met with almost total media silence, at least in western countries. Why? Could it be because the circumstances of these everyday, "ordinary" deaths just aren't as spectacular and "exciting" as natural disasters like tsunamis? Could it be because people in richer countries—especially those in power—don't care as much about what happens to poor, non-white people on the other side of the world?

What if the world invested just half as much money and resources each year into preventing these deaths, as it usually spends to help disaster survivors? Countless lives could be saved on an ongoing basis. Perhaps some of these diseases could even be eradicated. But because disasters are sudden, dramatic, and newsworthy, "ordinary" deaths that happen every day are easily forgotten and marginalized.

The annual death toll from pregnancy complications is particularly tragic. Out of 510,000 maternal deaths, less than 2,500 occur in developed countries.²  While one woman in 2800 can expect to die from a pregnancy in the developed world, one in 16 will die in poorer regions. This represents the largest disparity between developed and developing regions of any health statistic. Also, for every pregnant woman who dies, about 30 suffer serious injury, infection, or disability—that's over 15 million women a year. Babies often don't survive either—3 million infant deaths and stillbirths occur every year as a result of pregnancy complications and maternal death. And when a pregnant woman dies, her existing children have a much higher risk of dying within the next two years.³ Maternal mortality doesn't affect just women—it devastates entire families and societies.

Why do maternal deaths occur and what can be done to prevent them? The table below lists the most common causes of maternal death.

Source: World Health Organization. 2003. Making Pregnancy Safer. http://w3.whosea.org/pregnancy/chap2.htm

The World Health Organizations states: "Maternal mortality offers a litmus test of the status of women, their access to health care, and the adequacy of the health care system in responding to their needs."⁴ The most common situation that pregnant women in developing countries face is no access to healthcare or poor quality healthcare, both of which are caused or made worse by poverty and ignorance. All these factors reflect a lack of commitment to women's health and welfare by governments and policy-makers.

One study listed the following major risk factors for maternal deaths in developing countries:⁵

• poor quality or no maternal health care
• female illiteracy
• teenage pregnancy (often because of forced early marriage)
• high parity (having several children already)
• delays in reaching and receiving healthcare services
• unsafe abortion in countries where it is still illegal
• malaria, HIV, anemia (pre-existing illnesses)
• harmful traditional medical beliefs and practices
• inadequate facilities to deal with obstetric emergencies
• deteriorating economies
• gender violence
• pregnancy in women over 40 with high parity
• civil war

Other contributing factors to maternal deaths include malnutrition, little access to contraception, lack of obstetric drugs, and repressive laws and policies. In recent years, some of these risk factors have improved, while others have gotten worse, including deteriorating health services and civil war. For example, President Bush's 2001 "global gag rule" (which prohibits healthcare agencies in foreign countries from even mentioning abortion if they want to receive U.S. funds) has led to significant increases in maternal and infant deaths in some developing countries, because many women's health clinics have been forced to close down or turn away patients needing help.

Africa is home to a disproportionate number of maternal deaths—just over half of the world's total. In some parts of the continent, 1 in 7 women die from pregnancy. This is where another important risk factor comes into play. Tens of thousands of women's lives could be saved in Africa with the simple allocation of a drug that's already safely used in the rest of the world: misoprostol, a synthetic prostaglandin. This essential drug is used to induce labour, soften the cervix, stop postpartum bleeding, and treat missed or incomplete abortion. Misoprostol literally saves pregnant women's lives when they experience eclampsia and hemorrhage. But misoprostol is not registered for use in most African countries because of politics. The drug is not profitable to the U.S. pharmaceutical firm that manufactures it. In July 2005, WHO added misoprostol to its list of essential medicines, but only when used together with the abortion pill mifepristone, and only "where permitted under national law and where culturally acceptable." This has zero benefit for most African countries, where abortion is still widely illegal. Governments and policy-makers in African countries could insist on making misoprostol available by itself, but they don't, probably because women's healthcare tends to be overlooked and ignored due to the very low status of women in Africa. This in turn translates to a lack of political will to fix the situation.

Although reduction of maternal mortality is one of the major goals of the World Health Organization, much remains to be done. High rates of maternal deaths have persisted since the International Safe Motherhood Initiative was launched in 1987.⁶ The struggle has been hampered by logistical problems in counting and estimating maternal deaths, and an initial lack of consensus on effective strategies. It's also proven very difficult to provide healthcare in remote or war-torn areas, obtain resources and funding, educate women in countries where most women are illiterate, and persuade local governments to implement progressive laws and policies. For example, criminal laws against abortion should be repealed because they do nothing to stop abortion. Instead, they force 20 million women to resort to dangerous illegal abortions every year, killing 70,000 of them and maiming millions. Unsafe abortion is also the only cause of maternal mortality that is entirely preventable.

The global community has its priorities skewed. Politics and public relations are driving the phenomenal response to the tsunami and other disasters, while a massive tidal wave of death continues to swamp large parts of the world—largely out of sight and out of mind. Disaster victims certainly deserve our help, but our generosity is wildly out of proportion when we consider the millions of preventable deaths that occur year after year in developing regions. In particular, maternal mortality numbers are a glaring example of politics trumping human rights. Reducing maternal mortality cannot be achieved in isolation from the broader issue of gender inequality, or by avoiding hot topics like illegal abortion. Put simply, if women were valued and respected, resources would be made available to ensure their well-being and guarantee their rights. Meanwhile, millions of women continue to suffer and die needlessly, along with their children.

Endnotes

1.    About one-fifth of deaths from respiratory infections occur in developed countries. The numbers of deaths for other listed conditions are almost negligible for developed countries    

2.    World Health Organization. 2004. Maternal Mortality in 2000: Estimates developed by WHO, UNICEF, UNFPA. http://www.who.int/reproductive-health/publications/maternal_mortality_2000/

3.    The Panos Institute. 2001. Birth Rights: New Approaches to Safe Motherhood. http://web.archive.org/web/20030218010654/www.panos.org.uk/briefing/birth_rights_files/birth_rights.htm

4.    World Health Organization. 2004. Beyond the Numbers: Reviewing maternal deaths and complications to make pregnancy safer. http://www.who.int/reproductive-health/publications/btn/

5.    Mohamed, Nasr Adbalia. 2003. Maternal Mortality. Sudan Ministry of Health, Sudan Fertility Care Association. (A review study summarizing studies by the World Health Organization from 1998 to 2003). www.gfmer.ch/Endo/Course2003/Maternal_mortality.htm

6.    The Panos Institute. 2001. Birth Rights: New Approaches to Safe Motherhood. http://web.archive.org/web/20030218010654/www.panos.org.uk/briefing/birth_rights_files/birth_rights.htm