Maternal Mortality: a Global Factbook

Every year halfa million women die as a result of pregnancy-99% of them in developing countries.Most ofthe deaths are preventable, but the enormity of the task generates the kind ofcompassion fatigue induced by Oxfam mailshots.We forget that only 60 years ago maternal mortality in Britain was as high as it is today in Central Africa, where one in every 200 pregnant women dies.Our rate was reduced to 1 in 10 000 not by a social revolution but by the efforts ofhealth workers and politicians, after society decided that something must be done.An important factor was the Confidential Enquiry into Maternal Deaths, which gathered detailed information on each case.Only then could steps-ranging from providing more anaesthetists to legalising abortion-be taken to eradicate pre- ventable causes.Maternal mortality, a globalfactbook is part of WHO's "safe motherhood initiative" aimed at halving maternal mortality by the year 2000.The book-the size of a large telephone directory-is the companion to the 1989 WHO publication Preventing maternal deaths, which suggested ways of combating the problems.This new volume contains background information sometimes hard to find in developing countries-for example, on demography, health expenditure, fertility, and female age at marriage (16 years in Chad, 30 in Haiti).Everywhere literacy is lower among women than men: in Afghanistan the female literacy rate is 8%, the male rate 39%.From many sources-government esti- mates, hospital studies, and doctoral theses- the book draws information on maternal deaths and avoidable causes.This is a far cry from Britain's committee of experts poring over the details of each death, but it is an essential starting point.A British obstetrician feels humbled to think of 150000 women bleeding to death and 100000 dying from illegal abortion.The effort involved in com- piling this book must have been considerable, but it is hard to imagine a more worthwhile project.