Women: The Forgotten Half of the World

By Madeline Price

Warning: Article contains potentially triggering discussion of abortion, childbirth and related diseases. 

Maternal health in third world countries has never been on the decline, simply because it has never been at a high enough standard from which to decline.  Every single day, more women die in labour than can fill five jumbo jets – that’s over 1 700 women each day – yet the maternal health of women is not a forefront issue for the global society.  Maternal health has been all but forgotten by the organisations, by the people, claiming to change the third world. 

The horrific standards of third world maternal health were first discussed in the late 1990’s within an article written by Peter Adamson, the founding editor of New Internationalist.  Back then, the estimated figures surrounding maternal health were shocking.  Today, they are horrifying. 

In 1997, it was conservatively estimated that over 200 000 women die each year from uncontrollable haemorrhaging alone, during childbirth.  This haemorrhaging would be treatable in a western facility; a luxury rural, third world women cannot enjoy.  Another 75 000 women die from attempting to abort their own pregnancy, many of whom are merely teenagers.  Daily, over 50 000 women attempt such an act, using sharp objects inserted into the uterus – a straightened coat hanger, a knitting-needle, a sharp stick.  Survivors of such procedures often must live in crippling discomfort. 

Furthermore, another estimated 100 000 women contract and die of sepsis, where the bloodstream is poisoned by an infection from an unhealed uterus or retained fragments of placenta.  Somewhat smaller numbers perish from anaemia so severe that their vital organs begin to fail.  Finally, a further 40 000 women die from obstructed labour, where the baby’s skull, already asphyxiated by this stage, repeatedly grinds down upon the tissues of a pelvis that is just too small.  In 1997, it was estimated that just over 1 600 women die each day from problems related to maternal health. 

These figures may be shocking, but they pale in comparison to the present day estimates.  In 2001, UNICEF released figures revealed from their own research and data collection, predominantly that, a women in sub-Saharan Africa stands a one in 16 chance of dying during pregnancy or childbirth.  In comparison, women in the developed world stand a mere one in 2 800 risk.  Similarly, in 2005, the World Health Organisation proclaimed that over 536 000 women died during childbirth or pregnancy in that year alone.  Of these 536 000 deaths, 95% occurred in Africa and Asia, whilst 4% occurred in Latin America and the Caribbean, and a mere 1% occurred in the remainder of the developed world.  This mere 1% equalled the lives of 2 500 women, a number made all the more astounding with the realisation that it is just one percent of the problem. 

UNICEF, however, purported another important point in relation to maternal mortality: women aren’t the only ones who suffer.  In 2001, it was estimated that greater than 20% of the diseases in children below the age of five directly correlates to poor maternal health and nutrition, in addition to the quality of care throughout delivery.  Furthermore, annually, over eight million babies die during delivery or their first week of life. 

Upon releasing these latest figures, UNICEF remarked that ‘[i]t is no exaggeration to say that the issue of maternal mortality and morbidity, fast in its conspiracy of silence, is in scale and severity the most neglected tragedy of our times’.  James Wolfensohn, President of the World Bank takes it one step further in emphasising, ‘[w]hy is it that a woman dies every minute?  The answer is that people don’t care.  We assume that women are there.  We have never taken enough concern about the rights of women [sic]’. 

By far the most reliable and confronting record of maternal mortality remains the Maternal Mortality Ratio (MMR).  This measures the number of deaths to women due to pregnancy-related complications, including childbirth, per 100 000 live births.  To compare, Ireland, the safest place on earth to go through pregnancy and childbirth, has a Maternal Mortality Ratio of just one.  This means that, for every 100 000 births, only one woman is lost. 

South Asia, on the other hand, has a MMR of 490.  This includes the development capital of India, which, for all its claims of progress in the economic stakes, still provides women with a one in 70 chance of dying during childbirth in her lifetime.  Comparatively, sub-Saharan Africa has a MMR of 900, whilst Sierra Leone takes the cake at 2 100 deaths per 100 000 live births.  Globally, a mere 13 third world and developing countries account for over 70% of maternal deaths. 

However, as was alluded to earlier, maternal death isn’t the only issue of concern under the broad spectrum of maternal health.  For every woman who dies during childbirth or pregnancy, another 30 suffer lifelong pain, illness or permanent disability. 

Whilst obstructed labour, sepsis and anaemia are all widely known, the most common and horrific injury is that of fistula.  This occurs predominantly during prolonged labour, when tissues within the birth canal are deadened from days of pressure from the baby’s skull.  Following the removal of the deceased baby, these tissues slowly start to fall away, leaving gaping holes.  These holes allow for leakage from the bladder and rectum into the vagina, causing uncontrollable flow and incontinency.  Without an operation to repair the fistula, the woman suffers abrasions to her genital area and sores down her legs due to the acidity of her urine leaking from her bowels, a foul rotting smell emitting from her body and social exclusion. 

Often, and specifically within rural regions, the woman is branded as cursed, moved to a hut far on the outskirts of the village and forced to live out the remainder of her life fending off wild animals at night and making do within her hut during the day.  Whilst figures are inaccurate due to the inability to collect adequate data, it is estimated that over 80 000 women develop fistula every year, and an unknown number commit suicide, believing it is preferable to life. 

However, among all this morbidity is a ray of hope – maternal mortality, unlike more complex problems such as sex trafficking and world poverty, can be solved. 

Take, for instance, the recent example of Cuba.  Cuba, defined as a third world country, has been revolutionary in its ability to align the healthcare facilities of its rural population with that of its urban population.  Under Castro, Cuba initiated a system of health centres, known as polyclinics, in which doctors and nurses were responsible for a given group of families within a specific district, offering a ‘universal, institutionalised system of free rural and urban health care’.  By eliminating both the costs of health care and the concentration of decent care within only the major cities, Cuba brought it’s maternal health back from the brink and up to first world standards.  This lead to infant mortality decreasing from 36 per 1 000 live births before the revolution, to a mere eight in 1996, a reflection upon the increased maternal healthcare. 

Similarly, other programs worldwide have shown a decrease in maternal mortality correlates directly to an increase in health care facilities and the use of birth attendants.  For example, between 1990 and 2000, the use of birth attendants increased from 42% to 52% – a ten percent rise – with a potential decrease in maternal deaths.  These improvements, however, were restricted to the regions of South East Asia and Northern Africa.  Sub-Saharan Africa, on the other hand, showed slow improvements of a mere three percent. 

This lack of improvement showed one of the major problems with solving maternal mortality issues – culture.  Culture plays a major role in any achievable solution to maternal deaths.  For instance, in Ghana, a woman who is suffering through troubled or obstructed labour is seen as proof of infidelity, leaving the woman to stall in calling for assistance, instead choosing to appease the gods to help with her delivery.  Similarly, cultural rules in Papua New Guinea do not allow the use of a birth attendant, as it is believed that female blood is contaminated and could sicken, even kill, a birth attendant.  Such cultural rules and beliefs dictate what solutions would be viable and achievable in various regions. 

It must be emphasised, however, that these cultural rules do not only apply to those in the third world.  A study of a sect within the United States, whose members were well nourished, wealthy and well educated, but did not accept modern medical care, proved that high levels of maternal mortality could exist in the western world, due to cultural rules.  In this particular sect, the maternal mortality ratio was over 100 times the U.S. average, being equivalent to that of rural India. 

In light of the cultural rules that dictate various aspects of the societies that most require help, solutions that encompass and consider these rules are required.  Whilst birth attendants do increase the chances of survival and improve maternal health, such a solution will not work in countries like Papua New Guinea and Ghana.  Similarly, expensive facilities in urban areas will not improve maternal health as much as polyclinics in rural areas would.  In order to solve the worsening crisis that is maternal health, solutions need to consider the problems they will be solving. 

After all, maternal health is an issue that affects everyone, let alone those 536 000 who perish each year. 

~ Madeline Price

References

Kristof, N. and Wudunn, S. (2009) Half the sky: how to change the world, United States: Random House, pg.  110. 

Adamson, P. (1997) Deaf to the Screams, New Internationalist

Jones, A. (1999) Maternal Morality, Gendercide Watch (online) http://www.gendercide.org/case_maternal.html, accessed the 25th of January 2012. 

UNICEF (2001) Millennium Development Goal: Improve maternal health, UNICEF Organisation (online) http://www.unicef.org/mdg/maternal.html, accessed the 25th of January 2012. 

World Health Organisation (2003) Maternal deaths disproportionately high in developing countries, WHO (online) http://www.who.int/mediacentre/releases/2003/pr77/en.index.html. 

Davies, R. (2011) Maternal health – an international cause worth fighting for, The Guardian (online) http://www.guardian.co.uk/global-development/poverty-matters/2011/jan/18/maternal-health-uk-government-framework, accessed 25th January 2012