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Maternal mortality across the world



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Jim Scythes speaks after wife's death in childbirth

The US spends more money on mothers' health than any other nation in the world, yet women in America are more likely to die during childbirth than they are in most other developed countries, according to the OECD and WHO. The BBC's Laura Trevelyan has been trying to find out why.

Four million American women give birth every year, and about 500 die during childbirth or from pregnancy-related complications.

In the richest nation in the world, giving birth is more risky than you would think.

"No American woman should die from childbirth in 2009, we can definitely do a lot better," says Dr Michael Lu, Associate Professor of Obstetrics at the University of California, Los Angeles (UCLA).

In New Jersey, Jim Scythes is bringing up his two-year-old daughter Isabella on his own.

His wife, Valerie, died from blood clots shortly after giving birth to Isabella by Caesarean section.

Jim still cannot believe that Valerie died after giving birth, here in America.

"When Isabella walked for the first time, I sat on the floor and cried, because Valerie should have been there. I believe this could have been prevented and now my daughter will never know her mother."

MATERNAL MORTALITY
One woman dies every minute during childbirth, yet almost all of these deaths are preventable.

In 2001, the UN set itself the goal of slashing maternal mortality by 75% by 2015, but it is nowhere near meeting that target.

Health ministers from around the world are meeting in Ethiopia to work out how to make up for lost ground.

The BBC is publishing a series of reports to mark the occasion.

So why are women in America more likely to die during childbirth than they are in most other developed nations?

The answers are complex. A healthcare system which leaves what Dr Lu estimates are 17 million women of child-bearing age without health insurance could be one factor.

Obesity, poverty and the high rate of C-sections in America all play a part.

Dr Lu says about half of American women are entering pregnancy overweight. "Obesity is a major risk factor for pregnancy-related complications.

"First we need to improve the health of women before they get pregnant, and second we need to improve the quality of maternal care in America."

Shocking story

The Centres for Disease Control (CDC) in Atlanta is the US government agency that collects national statistics on the numbers of women dying during childbirth.

Dr Bill Callaghan of the CDC says the latest maternal mortality data suggests one in four to one in five women who die have heart disease, or diseased blood vessels.

To the extent that we don't explain racial disparity in pregnancy-related mortality, we're going to have difficulty making headway into it
Dr Bill Callaghan
Centers for Disease Control

Could that be due to women being overweight? I asked. "It could be," replies Dr Callaghan, "the obesity epidemic has not spared women of reproductive age."

Dr Bill McCool, at the University of Pennsylvania's School of Nursing, points out that America is far above the World Health Organization's goal of a 15% C-section rate.

"Surgery of any kind has risk," he says, and a C-section is, "still the riskiest way to have a baby.

"In the US, almost one third of women have that procedure for delivery of their baby."

The statistics on maternal mortality in America tell a shocking story when it comes to African-American women.

They are three to four times more likely to die during childbirth than white American women.

Dr Bill McCool says that even wealthy black American women have a higher rate of mortality during childbirth than wealthy white women.

"People have looked at this from different angles.

Maternal mortality around the world

"We know that African-American women tend to have higher blood pressure than the rest of the population, so is there a link there?"

JoAnne Fischer, Executive Director of the Maternity Care Coalition, which works with low income women to help them stay healthy during their pregnancies, says: "We do know that there is extraordinary stress involved in racism and in being poor. "

"And we know that sometimes this creates hypertension.

"Hypertension, obesity and diabetes are all linked, so we have to make sure women start their pregnancies healthy."

Dr Bill Callaghan, of the CDC, finds that not knowing why African-American women are at greater risk when giving birth has given him and his colleagues' sleepless nights.

"We can say that some of this may be due to socio-economic disparities.

"But it does not explain all of it.

"And to the extent that we don't explain racial disparity in pregnancy-related mortality, we're going to have difficulty making headway into it."

As doctors and US officials try to work out why American women are dying in childbirth, and what can be done to prevent it, Jim Scythes is still mourning his wife Valerie, who was all too briefly a mother.



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