Monday, September 25, 2006

Maternal mortality

Making Motherhood Safer, a report prepared by the Population Reference Bureau in 2002, contains some very enlightening statistics about maternal mortality. They have direct implications for the contention among natural childbirth advocates that childbirth is inherently safe:

"Women's Lifetime Risk of Death From Pregnancy, 1995

Sub-Saharan Africa 1 in 13
South Asia 1 in 54
Middle East and North Africa 1 in 55
Latin America and the Caribbean 1 in 157
East Asia/Pacific 1 in 283
Central East Europe/Commonwealth
of Independent States and Baltic States 1 in 797
Industrialized countries 1 in 4,085"

"The most recent figures from the World Health Organization, which releases revised global maternal mortality estimates about every five years, estimate that 515,000 women die annually from maternal causes...

Tragically, these deaths are just part of the picture. For every woman who dies, approximately 30 more women suffer injuries, infection, and disabilities during pregnancy or childbirth - at least 15 million women a year. The cumulative total of those affected has been estimated at 300 million, or more than a quarter of adult women in the developing world. These pregnancy-related health problems include severe anemia, infertility, and damage to the uterus and reproductive tract sustained during childbirth. Obstetric fistula (tears between the vagina and the urinary tract or rectum that cause permanent incontinence if not treated) are especially devastating."

"The majority of maternal deaths occur after childbirth - most within 24 hours. About a quarter take place during pregnancy, and about 15 percent happen at the time of delivery. The most common medical cause is hemorrhage, a swift and severe loss of blood before, during, or after delivery..."

"Skilled Care at Delivery and Maternal Deaths, Regional Comparisons

Sub-Saharan Africa 45% of women receive skilled care/967deaths per 100,000 births
South Asia 59%/430
East Asia and Pacific 73%/189
Middle East and North Africa 77%/175
Latin America and Caribbean 83%/146
Central & East Europe/CIS(Russia)/Baltic 97%/45
North America 100%/9"

What does this tell us about the inherent safety of human childbirth? It tells us that it is not very safe at all. In countries where there is limited access to modern obstetrics, the lifetime risk of death from pregnancy and childbirth is 1 in 13; every woman has a 1 out of 13 chance that she will die of a pregnancy related complication. That has been reduced to 1 in 4085 in countries where every woman has access to modern obstetrics. This is the reason why most natural childbirth advocates think (erroneously) that childbirth is inherently safe. Modern obstetrics has been so spectacularly successful, that most Western people have no clue about the dangers of childbirth.

The most common cause of maternal death is hemorrhage. Whatever herbs or natural techniques are being used, they cannot prevent 100,000 maternal deaths per year. Only pitocin, methergine and blood transfusions can do that - all products of modern obstetrics.

There are those who might argue that it is not medical care that is responsible for the dramatic disparities in maternal deaths around the world, but poverty, malnutrition and sanitation. However, the relationship between modern obstetrics and decreasing maternal death is emphasize by examination of the proportion of women seen by skilled attendants and the number of maternal deaths. The above figures demonstrate that maternal mortality is directly related to proportion of women who received skilled care.


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