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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)


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

The villagers hoisted the pregnant woman onto their shoulders, carrying her in a crude stretcher made from a blanket and two sticks, and began trudging down the path to the nearest town.

The woman, 24-year-old Setew Tilahun, had gone into labour the night before. But the baby was twisted around inside her and could not come out. Nobody in her remote Ethiopian village could help her. And so her arduous journey began.

When the villagers finally reached the nearest town, late at night, after carrying her on their shoulders for six hours, the people at the health centre said they could do nothing for her. They found an ambulance and sent her on to the next town, a four-hour drive.

At 2 a.m., medical staff in the town of Fitche looked at her and said they couldn't help either. They put her back on the road again. At 4 a.m., she finally reached a hospital in the capital, Addis Ababa, where doctors found that her baby had died.

The mother, too, was barely alive, and needed emergency treatment to save her life. "She looked like a dead woman," says her brother, Getachew Mesaye, a 27-year-old farmer. "She fainted and it took two hours to revive her."

It was the kind of small human tragedy that happens every day, all over the world. Close to 550,000 women die in pregnancy and childbirth every year - a rate of about one woman every minute - along with nearly 4 million infants who die within a month of birth. The grim statistics reflect one of the most stubbornly intractable and neglected crises in the world, which persists despite endless studies and debates and vague promises of help.

For women in Africa and Asia, the act of giving life - having a child - is one of the most dangerous risks they can take. Their chances of dying in childbirth can be more than 100 times greater than a Canadian or American woman would face.

This week, Prime Minister Stephen Harper became the latest in a string of politicians to pledge action. He promised that maternal and child health would be Canada's "top priority" at the G8 summit in June.

When Setew Tilahun had difficulty in delivering her baby, her brother Getachew Mesaye, left, and other villagers took her on an arduous journey to get help. By the time they finally reached doctors who could help, her baby was dead and she had almost died.

The commitment followed a campaign of quiet backroom lobbying by a coalition of Canadian advocacy groups, including the Canadian branches of CARE and UNICEF, which had written to Mr. Harper several months ago to urge him to use Canada's role as the G8 host to put maternal health at the top of the agenda.

Yet it will take more than political rhetoric to reverse the decades of neglect and broken promises. History shows that governments around the world have been willing to tolerate the deaths of millions of women without the furor that would surround an earthquake or an epidemic.

In 1987, at a major international conference in Nairobi, governments pledged to cut the maternal death toll in half by 2000. Nothing happened - except that the death toll kept climbing relentlessly.

When the United Nations set its new "millennium development goals" for the developing world a decade ago, it aimed to reduce maternal deaths by 75 per cent by 2015. Today this target has been the most dismal failure of any of the UN's eight millennium goals. At the current agonizingly slow rate, the target will not be met until 2076 in Asia - and many years later in Africa.

Carol Bellamy, who headed UNICEF from 1995 to 2005, has seen the promises come and go, and she has seen governments continuing to ignore the maternal-death crisis. "It's just so frustrating that it hasn't received more recognition over the years," she says.

"First and foremost, it's because it is women, and women are seen as second-class citizens. Governments are still more male than female. There's certainly been more progress on children's health, because politicians like to talk about kids."

Yet it would actually be easier for politicians to make progress on maternal deaths, compared to higher-profile issues such as AIDS or malaria, if they truly wanted to solve the problem, she says. "It doesn't require a scientific breakthrough, like AIDS or malaria. It just requires leadership, and a recognition that it exists as an issue."

Human-rights advocates Mary Robinson and Alicia Yamin put it more bluntly: "The reason that women are still dying is because women's lives are not valued, because their voices are not listened to, and because they are discriminated against and excluded in their communities and by health-care systems."

The problems are simple, the solutions cheap

Most maternal deaths are easily preventable when basic care is available. In fact, maternal deaths have been virtually eliminated in Canada and other wealthy countries. But the gap between rich and poor countries is shockingly wide. In Canada, the lifetime risk of maternal death is just one in 11,000. In Ethiopia, the risk is one in 27. In Angola and Liberia, the risk is one in 12. And in Niger - the worst in the world - the lifetime risk of maternal death is one in seven.

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