The most neglected tragedy

Posted: 13 February 2003

Author: Peter Adamson

Author Info: Peter Adamson was responsible for UNICEF's State of the World's Children report for 16 years.

For a decade the figure of 500,000 maternal deaths a year was part of the statistical liturgy. Then, in 1996, new estimates showed that the number of women dying each year in pregnancy and childbirth was probably closer to 600,000 - a figure that is little changed today

BangladeshCarrying ill wife to health centre, Bangladesh© Paul Harrison/Still PicturesBut before new estimates replace old ones as a way of packaging up the problem, it should be said that a mistake has been made in allowing statistics such as these to slip into easy usage. For these are not deaths like other deaths, and death is only a part of the story they have to tell.

They die, these hundred of thousands of women whose lives come to an end in their teens and twenties and thirties, in ways that set them apart from the normal run of human experience.

Over 200,000 die of haemorrhaging, violently pumping blood onto the floor of the bus or bullock cart of blood-soaked stretcher as their families and friends search in vain for help.

About 75,000 more die from attempting to abort their pregnancy themselves. Some will take drugs or submit to violent massage. Alone or assisted many, choose to insert a sharp object - a straightened coat-hanger, a knitting needle, or a sharpened stick through the vagina into the uterus. Some 50,000 women and girls attempt such procedures every day. Most survive, though often with crippling discomfort, pelvic inflammatory disease and a continuing foul discharge. And some do not survive: with punctured uterus and infected wound, they die in pain and alone, bleeding and frightened and ashamed.

Perhaps 75,000 more die with brain and kidney damage in the convulsions of eclampsia, a dangerous condition that can arise in late pregnancy and has been described by a survivor as "the worst feeling in the world that can possibly be imagined."

Another 100,000 die of sepsis, the bloodstream poisoned by a rising infection from an unhealed uterus or from retained pieces of placenta, bringing fever and hallucinations and appalling pain.

Smaller but still significant numbers die of an anaemia so severe that the muscles of the heart fail. And as many as 40,000 a year die of obstructed labour - days of futile contractions repeatedly grinding down the skull of an already asphyxiated baby onto the soft tissues of a pelvis that is just too small.

But the numbers of dead alone do not reveal the full scale of this tragedy. For every woman who dies, approximately 30 more incur injuries, infections, and disabilities which are usually untreated and unspoken of, and which are often humiliating and painful, debilitating and lifelong.

This means that at least 12 million women a year sustain the kind of damage in pregnancy and childbirth that will have a profound effect on their lives. And even allowing for the fact the some women will suffer such injuries more than once during their child-bearing years, the cumulative total of those affected can be conservatively estimated at some 300 million, or more than a quarter of the adult women now alive in the developing world.

It is therefore no exaggeration to say that the issue of maternal mortality and morbidity, locked fast in its conspiracy of silence, is in scale and severity the most neglected tragedy of our times.

  • A woman dies every two hours in Nepal due to birth complications, according to report by Radio Nepal in February 2003.

    "Maternal mortality in the country is put at 539 per 100,000 births, one of the highest in South Asia," the state-run radio quoted Arju Rana Deuba, honorary chairperson of the Safe Motherhood Network, as saying (though international agencies such as WHO put the figure at 1500 per 100,000 births,when under-reporting is fully taken into account).

    "More than 80 per cent of the women die before reaching hospital due to ignorance about birth preparedness and complication readiness prior to delivery," Deuba said, adding that 20 per cent die after they are taken to hospital.

    Despite the availability of medical facilities and services, they cannot be used unless there is awareness among the Nepalese people, Deubaadded.

    At least 4,000 women lose their lives during child birth every year in Nepal.