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World population Tuesday, 29 June, 1999, 18:30 GMT 19:30 UK
Death in the midst of life
By BBC News Online's Mandy Garner

World Population
More than one woman a minute dies as a result of problems related to childbirth and pregnancy.

In many developing countries these are the leading cause of death among women of reproductive age.

According to the World Health Organisation, an estimated 585,000 women die every year as a result of pregnancy and childbirth.

Fewer than 1% of the deaths happen in developed countries.

Aid agencies say the difference in death rates between developing and developed countries is a key marker of the world's health inequalities and shows that the majority of lives could be saved.

In addition to deaths, complications arising in pregnancy and birth can have long-lasting health effects.

Click here to see the global picture of risk for maternal death.

It is estimated that 300m women have become ill as a result of pregnancy and giving birth. Most deaths are linked to the act of childbirth, with the leading cause being severe bleeding.

Other significant factors include unsafe abortion, which accounts for about 75,000 or 13% of deaths.

The 1994 UN conference in Cairo was the first international conference to put unsafe abortion on the public health agenda.

After much debate, wording was agreed which kept both anti- and pro-abortion lobbies happy.

The conference said abortion should not be provided as a form of family planning, but, where it was legal, it should be safe. Where it was not, it should be treated as a public health problem.

Health experts say they expect both sides will want to maintain the status quo at the New York population conference.

Poverty

Poverty is the key factor in maternal death rates. African women are at highest risk of death. The average African woman faces a one in 16 risk of dying from pregnancy or childbirth.

This compares with a one in 28 risk for all developing countries and a one in 1,800 risk for women in developed countries.

However, in individual countries, the risk can be even higher. Ethiopian women face a one in nine chance of dying.

Women's health in pregnancy and the healthcare they receive in childbirth has a knock-on effect on their children.

Some eight million are born dead or die within a week of birth.

The World Health Organisation (WHO) says death rates could be vastly improved if women had greater access to ante-natal and post-natal care.

Women in developing countries are much less likely to access ante-natal care than those in developing countries and the majority do not receive any post-natal follow-up.

In the poorest countries, only 5% of women receive post-natal care.

The WHO says there are no trained childbirth specialists present at almost half of all births in developing countries.

Part of the problem is due to a lack of accessible health services, but the cost of getting help and women's position in the family are also factors.

It says the majority of the problems can be resolved for as little as $2 a person per year in low-income countries.

Funding problems

In Cairo, governments pledged to reduce maternal deaths by three quarters by 2015.

Access to adequate healthcare in pregnancy can save many lives
It also set tough targets for reducing infant and under-five death rates.

Family planning agencies say these will not be attained without proper funding.

Developing countries have, for the most part, lived up to their commitments. But developed countries are accused of failing to meet their obligations - mainly because of general cuts in their overseas aid budgets.

They promised to fund a third of the $19bn a year needed to achieve the year 2000 targets. But, despite an initial boost in investment, they are likely to fall well short of the $5.7bn a year figure.

The United Nations Population Fund says the shortfall could spell up to 99,000 maternal deaths a year and around 1.6m deaths a year of infants and children under five.

One country which is feeling the effects of a fall in internal investment in family planning is Indonesia.

Due to the country's economic problems, funding for the country's leading family planning body has decreased by 35%.

Dr Azrul Azwar, president of the country's Planned Parenthood Association, says: "We are very worried that there could be a population problem again."

Empowering women

Dr Gro Harlem Brundtland, director general of the WHO, says the organisation needs to convince governments "that investing in health is also a good investment in economic growth".

She has cited an Egyptian study showing that for every pound invested in family planning, 30 was saved in future expenditure on food, education, housing and health.

She believes better family planning can reduce poverty by increasing women's ability to contribute to a country's wealth.


Links to more World population stories are at the foot of the page.


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