The 10 worst places to be an expectant mother

LONDON (AlertNet) - Every day 1000 women die in childbirth or from pregnancy complications. A chronic shortage of midwives is one of the main reasons for this high rate of maternal mortality.

As the world marks International Day of the Midwife, medical charity Merlin is calling for urgent investment to make up for the shortfall in health workers in conflict and crisis countries. 

Here is Merlin’s list of the most dangerous places to be an expectant mother. The list is based on figures produced by the United Nations.

1 - Afghanistan (1400 maternal deaths per 100,000 live births) - This is the deadliest place in the world to give birth. Afghanistan’s rugged terrain, extreme weather and lack of roads mean many rural women simply can’t get to health centres, especially in winter when floods and avalanches are common. With little money for even the basics, let alone luxuries like petrol, many pregnant women are forced to take donkeys to the hospital but end up giving birth on the roadside during the long journey – and often losing their lives.

2 - Chad (1200/100,000) - This central African country only has one midwife for every 100,000 people. A girl growing up in Chad today has nearly the same chance of dying in childbirth as she has of attending secondary school. Owing to political instability and corruption, there has been little investment in the health service. In some hospitals, women are forced to give birth on dirt floors.

3 - Somalia (1200/100,000) – This Horn of Africa country has been ravaged by civil war for the last 15 years which, when combined with years of severe drought and famine, has devastated the health service.  One in ten children dies before their first birthday. Many women must travel through the desert by camel to reach clinics.

4 - Guinea-Bissau (1000/100,000) - The capital has just one equipped surgery room. In remote rural areas women have to travel by canoe to reach qualified care. Caesareans cost $109 but two thirds of the population live on just $2 a day.

5 - Liberia (990/100,000) – This West African country has high maternal mortality rates but the recent influx of refugees fleeing violence in Ivory Coast means health services are even more squeezed. More than 100,000 Ivorians – mostly women and children – have arrived in Liberia in recent months. Refugees, made up mostly of women and children, walk for days and weeks to cross the border. Pregnant women who go into labour during the journey are forced to give birth in the bush.

6 - Sierra Leone (970/100,000) - One in eight women risks dying during pregnancy or childbirth. Every year 536,000 women die, mostly from bleeding and infection. Women die in their homes and others on their way to hospital in taxis, on motorbikes, or on foot. With access to a trained health worker, 75 percent of these women could be saved.

7 - Burundi (970/100,000) - Women with health complications are referred to city and district hospitals and can often spend all their family’s money on the journey there, only to be turned away due to overcrowding. Hospitals often detain patients unable to settle their bills.

8 - Central African Republic (850/100,000) – The country has just one midwife for 55,000 people. Insecurity has ravaged the country leaving many health centres abandoned and without proper equipment, including simple beds and stretchers. Merlin’s short film about a midwife named Olga highlights the problems.

9 - Nigeria (840/100,000) - Some 59,000 women die every year during pregnancy and childbirth. Just hours away from giving birth, heavily pregnant women travel unprotected on motorbikes. Others are forced to beg to raise the money to pay their hospital fees without which, they are forced to give birth at home where they are far more likely to die or suffer complications.

10 - Mali (830/100,000) - Although some hi-tech maternal health centres have been built, deaths have not decreased because women can’t get to them. Those living in rural areas are faced with abandoned hospitals that don’t even have mattresses on the beds.

For a story on the situation in Afghanistan's northeast, click here.