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Report spotlights women's 'unimaginable suffering'

Tuesday, 11 June 1996: New estimates show that almost 600,000 women die in pregnancy and childbirth each year, and for every woman who dies, 30 more suffer often humiliating, painful and debilitating infections, injuries and disabilities.

This is "a conspiracy of silence ...a story of unimaginable suffering," says the latest issue of The Progress of Nations, the UNICEF report that ranks countries according to their achievements in child health, nutrition, education, family planning, and progress for women.

"It is no exaggeration to say that this is one of the most neglected tragedies of our times, when 1,600 women – some in their teens – die every day during pregnancy or childbirth and many of these deaths are readily preventable," UNICEF Executive Director Carol Bellamy said today at an international news conference in Paris to launching the annual publication.

Latest estimates show that 1 in 13 women in sub-Saharan Africa dies of maternal causes, as does 1 in 35 women in South-central Asia. The figure for Western Europe is 1 woman in 3,200, the United States 1 in 3,300, and Canada 1 in 7,300.

More comprehensive than those in earlier studies, the figures compiled by UNICEF, the World Health Organization and Johns Hopkins University show a 20 per cent increase over previous estimates.

"UNICEF will continue its fight to get this issue onto the public and political agenda," said Ms. Bellamy, who also pointed out the serious implications of these statistics for children. According to the report, the nearly 600,000 fatalities leave at least a million children motherless.

The most common causes of death during pregnancy and childbirth each year include haemorrhage, which kills 140,000 young women, self-attempted abortion 75,000, sepsis 100,000 and obstructed labour 40,000. Three million have died from one or more of these since 1990.

In addition, a quarter of women in the developing world suffer from painful, humiliating, debilitating and often lifelong injuries related to pregnancy and childbirth. The most distressing is fistula, which develops in an estimated 80,000 women a year. Most cases go untreated, and between 500,000 and 1 million women are living with the problem at this moment, says the report.

To reduce such maternal mortality and morbidity rates, the silence that surrounds the issue needs to be broken, says UNICEF. Family planning services should be available to all who need them; good quality health care should be provided before, during and after pregnancy; and women should have better education and better nutrition. But above all, every pregnant woman should have access to skilled obstetric care – the modern medical care that made the difference in the industrialized world earlier this century. The report notes that in the United Kingdom, for example, it was not until the 1930s, when modern obstetric care began to cope with obstructed labour, haemorrhage and infection, that death rates began their sharp fall to today's levels.

According to the publication, giving women adequate obstetric care in developing countries would not be expensive. Affordable basic training in such care could be provided for doctors, midwives and nurses. This would ensure safer deliveries for most pregnant women.

"You don't need five-star hospitals," says the report. "There are thousands of hospitals in the developing world that, with minimum upgrading, could provide adequate obstetric care... But many are unusable for the lack of $100 worth of maintenance – a repair to an anaesthesia machine, the installation of proper lighting."

Child malnutrition

The Progress of Nations 1996 also casts a new light on one of the oldest problems of the developing world – child malnutrition. The report claims that, contrary to popular belief, malnutrition rates for under-fives are significantly higher in South Asia than in Africa. Half of the world's malnourished children are to be found in just three Asian countries – Bangladesh, India and Pakistan – where malnutrition rates are typically twice as high as in the poor countries of sub-Saharan Africa. The likely explanation for South Asia's high rates of malnutrition, says UNICEF, seems to be the region's far higher rates of babies with low birth weight, the generally lower status of many Asian women, the far greater population density, poorer hygiene and less satisfactory patterns of breastfeeding and weaning.

Child poverty

In a chapter on social issues in the industrialized world, The Progress of Nations 1996 looks at child poverty in the world's most economically successful nations. (Figures were not available for the Russian Federation.) With more than one in five of its children below the poverty line, the United States has the largest number of poor children among such countries. Four other countries – Australia, Canada, Ireland and Israel – have child poverty rates of more than 10 per cent. In 11 of the 18 countries surveyed, governments provide safety nets for children that reduce the numbers living in poverty by more than 10 per cent. In France, for example, government action has reduced the number of children living below the poverty line to 6.5 per cent.

In other comparisons, Sweden heads a new literacy league, Japan has the lowest teen birth rate, Finland the most 15-year-old smokers, and the Russian Federation the highest child accident rate. Most suicides among 15-to-24-year-olds are committed in Finland, Latvia, Lithuania, New Zealand, the Russian Federation and Slovenia.

The publication also examines the aid record of industrialized countries, noting that in 1994 – the latest year for which figures are available – development assistance was at its lowest level for 20 years. At the top of the aid league (percentage of GNP) are Norway, Denmark, Sweden and the Netherlands. The United States, New Zealand, Ireland and Italy come last.

In absolute terms, Japan and the United States give the most aid, joining France and Germany as the four countries donating two thirds of the world aid. Per person, Danes are the most generous; Canadians give twice as much as Americans, Japanese twice as much as Britons, Dutch twice as much as Germans.

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