Maternal Health and Mortality

Kristoff&Wudunn:

Eleven percent of the world’s inhabitants live in sub-Saharan Africa, and they suffer 24 percent of the world’s disease burden – which is addressed with less than 1 percent of the world’s health care spending.

The equivalent of five jumbo jets’ worth of women die in labor each day,

The amount we Americans spend on maternal health is equivalent to less than one twentieth of 1 percent of the amount we spend on our military. The World Health Organization estimates that 536,000 women perished in pregnancy or childbirth in 2005, a toll that has barely budged in thirty years. Child mortality has plunged, longevity has increased, but childbirth remains almost as deadly as ever, with one maternal death every minute.

Some 99 percent of those deaths occur in poor countries. The most common measure is the maternal mortality ratio (MMR). This refers to the number of maternal deaths for every 100,000 live births, although the data collection is usually so poor that the figures are only rough estimates. In Ireland, the safest place in the world to give birth, the MMR is just 1 per 100,000 live births. In the United States, where many more women fall through the cracks, the MMR is 11. In contrast, the average MMR in South Asia (including India and Pakistan) is 490. In sub-Saharan Africa, it is 900, and Sierra Leone has the highest MMR in the world, at 2,100.

One out-of-the-box way to reduce pregnancies is to subsidize school uniforms for girls. That keeps them in school longer, which means that they delay marriage and pregnancy until they are better able to deliver babies. A South African study found that giving girls a $6 uniform every eighteen months increased the chance that they would stay in school and consequently significantly reduced the number of pregnancies they experienced.

In much of the world, women die because they aren’t thought to matter. There’s a strong correlation between countries where women are marginalized and countries with high maternal mortality. Indeed, in the United States, maternal mortality remained very high throughout the nineteenth century and beginning of the twentieth century, even as incomes rose and access to doctors increased. During World War I, more American women died in childbirth than American men died in war. But from the 1920s to the 1940s in the United States, maternal mortality rates plunged – apparently because the same society that was giving women the right to vote also found the political will to direct resources to maternal health. When women could vote, suddenly their lives became more important, and enfranchising women ended up providing a huge and unanticipated boost to women’s health.