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When it came time to deliver twins, Nakbibi, 18, travelled three hours from her home in Faizabad, Afghanistan, to get medical help. Afghanistan still remains one of the world's most dangerous places for women giving birth. (Manca Juvan/Manca Juvan/Corbis)
When it came time to deliver twins, Nakbibi, 18, travelled three hours from her home in Faizabad, Afghanistan, to get medical help. Afghanistan still remains one of the world's most dangerous places for women giving birth. (Manca Juvan/Manca Juvan/Corbis)

Focus

Maternal mortality: <br/>Why it's a crisis Add to ...

Of the 10 million women who have died in pregnancy and childbirth since 1990, three-quarters of the deaths were preventable, primarily in Africa and South Asia. Millions of other women have been left with crippling injuries or illnesses as a result of poor care in childbirth. One of the most common birth-canal injuries, fistula, leaves many women so incontinent that they are ostracized by their families and villages.

This Tanzanian hospital is often so full it has to put two expectant mothers in the same bed.

For every woman who dies in childbirth or pregnancy, another 20 to 30 are left with illnesses and injuries that can be debilitating for life. And the consequences for the surviving children can be devastating. The children face a much higher risk of malnutrition, dropping out of school, or even death. Among infants who were born alive to mothers that died of maternal causes in Afghanistan, a study found that 74 per cent of the infants subsequently died too.

Even as economies improve, the deaths persist. India, with its booming economy, still suffers more than 135,000 maternal deaths every year. Despite the boom, India's government spends only 0.9 per cent of its gross domestic product on public-health services - one of the lowest percentages in the world. Its public-health clinics and hospitals are so under-equipped that they often refuse to admit pregnant women for fear they will die.

In the richest countries, too, there are pockets of high maternal deaths, revealing the patterns of poverty and inequality.

In the United States, for example, the maternal mortality rate among black women is 3.4 times higher than the rate for white women.

Many of the solutions are not expensive. A new study, released last month by the United Nations Population Fund and the Guttmacher Institute, estimates that 70 per cent of the world's maternal deaths - almost 400,000 lives - could be prevented if an additional $13-billion was spent annually on health care and family-planning services. The cost would be just a few dollars per capita. "It's not rocket science," the authors say. "What has taken so long?"

Most maternal deaths are caused by a brutally simple problem: a lack of health-care services. In the poorer countries of Africa and South Asia, the vast majority of women give birth at home, often lacking basic hygiene, because they cannot afford to travel to a hospital or clinic. Yet 15 per cent of these women suffer complications in labour, and usually there is nobody to help them. Millions of women with major complications get no treatment at all.

'It's almost like going into a killing field'

Even when hospitals and clinics exist, they are often so filthy and badly equipped that a pregnant woman stands a serious risk of dying from infection or bleeding. She enters the hospital and never returns.

In one regional hospital in Nigeria, a shocking 12 per cent of women are dying in childbirth. Many hospitals and clinics have no blood supplies, no antibiotics, and no running water. "It's almost like going into a killing field," says Sharmila Mhatre, a health specialist at the International Development Research Centre in Ottawa.

Afghanistan, where Canada has spent billions of dollars on foreign aid and military intervention, still remains one of the world's most dangerous places for women giving birth. About 25,000 women die from pregnancy-related complications in Afghanistan every year, and more than 90 per cent of deliveries take place at home, usually without any health attendants. The lifetime risk of maternal death in Afghanistan is one in eight - one of the worst rates in the world.

In five of India's poorest states, more than 90 per cent of primary health clinics do not have any blood-storage facilities - dooming women to death if they are bleeding heavily during labour complications - and more than 90 per cent cannot perform a Caesarian section.

"There's no way they can handle an emergency," says Jashodhara Dasgupta, co-ordinator of a women's health organization in India. "They don't want a death on their hands, so they keep turning women away, and they die on the road."

In Ethiopia, the government has drastically boosted its training programs for doctors and health extension workers, yet it is still handicapped by the exodus of thousands of doctors and nurses, lured away by better-paying jobs in Canada, the United States and Europe.

"I wish we had a trained person in my village," says Getachew Mesaye, the farmer who carried his sister for six hours to the nearest town. "If we did, we wouldn't be forced to travel all this distance to Addis Ababa."

He was lucky: He was able to borrow the equivalent of a year's income from other villagers to pay for his sister's transport and medical costs. But the loan repayments will burden him for years.

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