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Our Greatest Health Success -- and a Challenge

The 20th century brought many, many improvements in health. But by far the most remarkable was the incredible increase in the safety of childbearing.
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The 20th century brought many, many improvements in health, including a near doubling in average life expectancy from birth. But by far the most remarkable was the incredible increase in the safety of childbearing. What was formerly a distressingly common tragedy -- death of a woman as a result of pregnancy complications -- in the space of about two generations became vanishingly rare, at least in developed countries.

The relevant vital statistic is the "maternal mortality ratio," the number of women dying as a consequence of pregnancy per 100,000 infants born alive. In my recent book Whom the Gods Love: A Modern Medical Perspective on Illnesses that Caused the Early Death of Famous People, I assembled statistics from the past several centuries indicating that until about 1930 the maternal mortality ratio remained quite constant at 600-800 (per 100,000 live births). Then it began to decline very precipitously in the United States, to 380 in 1940, 83 in 1950, 37 in 1960, 22 in 1970, and less than 10 in 1980, where it has remained. This fall of 99% took place over 50 years, and no other public health index has come close to this phenomenal statistic.

Undoubtedly, multiple factors led to this rapid improvement, including blood transfusion to treat hemorrhage and antibiotics to fight infection. A major role must have been modern family planning techniques, permitting women to have children when and in what numbers they wanted and freeing them of the tyranny of unrestrained reproduction. Availability of safe, legal termination of unwanted pregnancies lessened the threat of criminal abortions. Improvements in general health and nutrition surely contributed. Underlying all factors were better understanding of pregnancy and birth and improved education of professionals involved in maternity care.

It is important to emphasize that this phenomenal improvement in the safety of childbearing has been largely limited to developed nations. Elsewhere maternal mortality remains high, in many cases appallingly so. According to the World Health Organization, more than 500,000 women die each year -- the equivalent of more than one per minute -- of pregnancy-related causes, and almost all of these deaths occur in developing countries.

Probably the worst place in the world to have a baby is Afghanistan, where a 2002 study by the (U.S.) Centers for Disease Control and Prevention and UNICEF found a ratio of 1600 (per 100,000 live births), more than 160 times that in the U.S and Western Europe. The same study found that the lifetime risk is one in maternal death is every eight females born. Let me say that again: one in every eight girls born in Afghanistan today will become a maternal death. In 2005, a consortium of international health organizations estimated the probability a 15-year-old female will eventually die from a pregnancy-related cause to be one in 26 in Africa, one in 62 in Oceania, and one in 120 in Asia, compared in with one in 7300 in developed countries.

What can those of us fortunate enough to live in favored circumstances do to address this tragic situation? First, we can tell our leaders and representatives that this is a matter of highest urgency and one that transcends political considerations. Then we can support organizations that address this terrible problem, such as Save the Mothers. I invite readers to suggest other ways to make a difference in saving mothers.