The Guardian (UK), October 3, 2006
SWEDEN BEST PLACE IN WORLD TO HAVE A BABY; Niger the Worst
Niger is officially the most dangerous place on earth to have a baby. A Save the Children report found that, of the 125 nations it surveyed, Niger was where childbirth was most likely to end badly. Women have a one in seven chance of dying during their reproductive years, and new born babies a 15 per cent chance of not reaching their first birthday and a one-in-six chance of not making it to the age of five. Only 16 per cent of deliveries are attended by anyone with any training at all.
The Save the Children report found that, while risk can never be entirely removed from the business of becoming a parent, the dangers for Swedish women are minuscule in comparison with the risks for mothers in Niger. A woman in Swedens chance of dying as a result of childbirth over her lifetime is one in 29,800. The risk of a new born baby dying in her first year is one in 333. In Sweden, 100 per cent of births are attended by a skilled, trained midwife. Overall, it is the safest place in the world to become a mother. More than 99 per cent of births in Sweden take place in hospital.
Niger is rated the world's poorest country by the UN. Around 14 per cent of its under-fives are significantly malnourished (and in the aftermath of last year's crop shortage and in the face of another shortfall this year, that figure could soon be much worse). Less than half its population has access to safe water.
In Niger, women are more than materially disadvantaged - they are educationally and physically disadvantaged too. Fewer than one in 10 is literate. Most girls marry early and have many children: the fertility rate, at 7.5, is among the highest in the world. Only 4 per cent use modern contraception and not for cultural or religious reasons, but because of lack of information and access.
Sweden, by contrast, is one of the wealthiest economies on earth. Its people are healthy and well-fed, its shops well-stocked, its communications excellent and its women well-educated, with virtually 100 per cent female literacy. More than 72 per cent use modern contraception and the average age for a first birth is 29. The fertility rate is 1.7. It is, in every way, a happier and healthier place to be a woman.
Unlike Sweden where excellent maternity care comes free of charge, Niger's women have to pay for the privilege of their substandard, inadequate services (while healthcare fees have been abolished in principle, they are still enforced in practice). And, although the sums are paltry by western standards - an antenatal check-up is 1,000 CFA, or 1; a new baby check-up is 5,000 CFA, or 5; a caesarean is 17,000 CSA, or 17. The amounts are impossibly large for impoverished families in a country where the average per capita income is 127,000 CFA or 127 a year.
In the village of Yawouri, outside Zinder, Niger nurse Abdulaye Hachiou explains that women often fail to seek help in labour because they - or their husbands - fear the expense. "You get husbands who say their wives can't be brought to the clinic because they don't want to pay the bill. And then the wife gets worse and they say, well there's no point in taking her now, she's going to die anyway."
Removing healthcare fees, says Save the Children, would save women's and babies' lives in Niger. But that is far from the whole solution. The country needs more trained midwives, well-equipped antenatal clinics, more obstetricians and a modern maternity unit in every town. In a perfect world, Niger would also have a vigilant system of postnatal care and beyond that, but equally important, clean water, a decent standard of living and good healthcare.
Anne Tinker, the Washington-based author of the report, says she believes seven out of 10 of the lives currently lost could be saved if a few low-cost measures were put into place. Education, she says, is key.
"If we could raise awareness of some of the health issues, we could save many lives," she says. "Women need to know about the danger signs in pregnancy. They need to know when to seek medical help. They need to know how important it is to get help in labour if things aren't progressing, rather than leaving it too late. And they need to know how to look after their newborns and when to take them to the health centre."
<< The Guardian -- 10/3/06 >>