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HEALTH: Maternal Mortality Shames Superpower U.S.

Haider Rizvi

UNITED NATIONS, Oct 13 2007 (IPS) - Despite its enormous wealth and highly advanced technology, the United States lags far behind other industrialised countries – and even some developing ones – in providing adequate health care to women during pregnancy and childbirth.

The U.S. ranks 41st in a new analysis of maternal mortality rates in 171 countries released by a group of U.N. public health experts on Friday. The survey shows that even a developing country like South Korea is ahead of the United States.

"Women are unnecessarily dying from pregnancy and childbirth complications because the U.S. is moving in a wrong direction," said Beneva Schulte of Women Deliver, a Washington-based group campaigning for women&#39s reproductive rights and access to public health care.

Based on 2005 estimates, the U.N. analysis suggests that one in 4,800 women in the United States carry a lifetime risk of death from pregnancy. By contrast, among the 10 top-ranked industrialised countries, fewer than one in 16,400 are facing a similar situation.

The reason? According to experts, in many European countries and Japan in the industrialised world, women are guaranteed good-quality health and family planning services that minimise their lifetime risk.

Many independent experts and sympathetic legislators hold the current U.S. public health policy responsible for its dismal record because some 47 million U.S. citizens have no access to health insurance, most of them African Americans and other minorities.

"We must ensure that pregnant women are covered," Congresswoman Lois Capps, a California Democrat, told IPS. "Even if we have the best technology, not everyone has the access to health care."

Capps also said the scope of the problem could be even worse than it appeared. "We have to improve our data collection," she said. "I don&#39t think we have all the data."

U.N. experts who prepared the analysis said they developed a new approach to estimating maternal mortality that seeks both to generate estimates for countries with no data and to correct available data for underreporting and misclassification.

They hold that inconsistency in data on deaths and on classification of those deaths creates broad uncertainties in many places, even in developed countries. But all estimates almost certainly understate the problem.

Responding to inquiries by IPS, a U.S. public health official identified "racial disparity" as the most significant factor underlying the high U.S. maternal mortality rate. "Black women are four times more vulnerable than whites," Eve Lackritz, chief of the Maternal and Infant Health branch of the Centres for Disease Control (CDC), told IPS.

In Lackritz&#39s view, obesity and hypertension are two leading causes of pregnancy-related risks in the United States. "We have to be more responsive," she said. "This is one of our big problems."

The U.S. situation within the industrialised world aside, the other end of the spectrum shows there are 10 countries – all of them in Africa except for Afghanistan – where high fertility and shattered health care systems are causing extreme risks for pregnant women.

According to researchers, in countries like Somalia, Mali, Chad, and Niger, on average more than one in every 15 women is likely to die of pregnancy-related causes. In Niger, the estimate suggests that one out seven women is vulnerable to death during pregnancy.

Their analysis comes at a time when many development activists and U.N. officials are trying to evaluate how far the world has progressed in meeting the Millennium Development Goals agreed upon by the world leaders some seven years ago.

When the world leaders attended a summit in New York in September 2000, they agreed that the MDGs must be achieved by 2015. That commitment included policy initiatives to reduce maternal mortality by 75 percent.

Many experts believe that in the past seven years nothing much has changed for the millions of poor women with regard to their economic wellbeing and access to health care.

As reported by the British medical journal the Lancet this week, at the current pace, there is almost no hope that the world will be able to achieve the 75 percent target.

Annually, about 20 million women undergo unsafe abortions, which, according to the journal, is a major factor in maternal deaths and illness.

Reproductive rights activists say that governments must take drastic steps to reverse the situation if they are serious in meeting the MDGs on reducing the maternal mortality rates in the next seven years.

"We still have the situation we had 20 years ago," said Ann Starrs of the independent group Family Care International in a statement. "Half a million women die every year from the complications of childbirth."

A recent study by Harvard University professor Ken Hill found that between 1990 and 2005, maternal deaths did fall, but by less than one percent a year. Hill and many other researchers estimate that at least 10 to 20 million women suffer injuries from the complications of childbirth every year.

Experts say this suffering could be easily avoided if international donors contributed just 6.1 billion dollars over the next seven years.

On Oct. 18-20, more than 1,500 world leaders will convene in London for "Women Deliver", a global conference that will focus on creating political will and strengthening health systems to prevent the deaths of "one woman every minute of every day during pregnancy or childbirth".

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