Making the investment in maternal health

In between shopping for a Mother’s Day card for my mom and browsing my recipe collection for a nice dessert to make for her this weekend, I came across Save the Children’s annual State of the World’s Mothers report.

The report delivers a cold, hard dose of reality about what motherhood means for many women worldwide: difficult, risky and uncertain in outcome. Health, education and economic indicators were analyzed for 165 countries with the following results: Norway was ranked the best nation in the world to be a mother; Niger was the worst. The United States? It ranked 25th among the 43 developed nations that were included in the analysis.

This year’s report zeroes in on nutrition during the critical 1,000 days at the beginning of life – from pregnancy through a child’s second birthday – and the global prevalence of malnutrition among mothers and babies.

Worldwide, the main nutritional threat to mothers and children isn’t obesity; it’s too few calories and the consequences this has on health. The report found, for instance, that more than half of the world’s children do not have access to the “Lifesaving Six”: iron folate supplementation during pregnancy, breastfeeding during the first six months, complementary feeding, vitamin A supplementation, zinc treatment for diarrhea, and adequate access to water, sanitation and hygiene.

The report explains why this is so critical:

Alarming numbers of mothers and children in developing countries are not getting the nutrition they need. For mothers, this means less strength and energy for the vitally important activities of daily life. It also means increased risk of death or giving birth to a pre-term, underweight or malnourished infant. For young children, poor nutrition in the early years also means irreversible damage to bodies and minds during the time when both are developing rapidly. And for 2.6 million children each year, hunger kills, with malnutrition leading to death.

The disappointing ranking for the United States was based on its poor showing at creating an environment supportive of mothers who breastfeed. This includes maternity leave laws and workplace policies that give women time to nurse.

Pregnancy, childbirth and infancy certainly are safer, at least in the industrialized world, than they used to be. At the start of the 20th century, for every 1,000 live births in the United States there were six to nine women who died of pregnancy-related complications and 100 infants who died before their first birthday. By 1999, thanks to improved education, public health measures and a higher standard of living, the mortality rate had fallen drastically – by 99 percent for mothers and 90 percent for infants.

These figures obscure some troubling facts, however. Maternal mortality actually has been increasing in the U.S., and at a faster rate than in any other developed nation. Nationally, deaths attributed to obstetrical causes within one year of giving birth rose from 7.6 per 100,0000 to 13.3 per 100,000 – this in a country that spends more per capita on maternal health than anywhere else. It’s in fact safer to give birth in Bosnia or Kuwait than it is in the United States.

The reasons are unclear. Part of the apparent increase may be due to improvements in data collection. But other factors may be involved as well: mothers who give birth later in life, when pregnancy- and childbirth-related complications are more likely; higher rates of caesarean deliveries and repeat caesareans that increase the risk of placental complications; and higher rates of diabetes, high blood pressure and other health risks among pregnant women. Some observers also believe the medical world has failed to successfully adapt its practices to a change in the paradigm, from young, mostly healthy women who give birth to mothers whose age, health status and background are more diverse and complex.

A report issued by Amnesty International in 2010 points to yet another cause: economic disparities and lack of access to health care for many U.S. women of childbearing age. It notes that among African-American women, the death rate from pregnancy-related complications is nearly four times that of white women, and that this disparity hasn’t budged in 20 years.

The most shameful fact about maternal and infant mortality? That the majority of these deaths, whether in developing nations or in the wealthy industrialized world, are considered preventable. The most common causes of death during delivery – uncontrollable bleeding, infection, high blood pressure, obstructed labor – can all be addressed with access to appropriate medical care. Improved nutrition for both moms and babies can make a big difference. So can factors such as alcohol use and tobacco exposure during pregnancy – and the list goes on and on.

It seems there’s still a long way to go before Mother’s Day is truly healthier for mothers and infants worldwide.

Photo: Wikimedia Commons