Magazine article New Internationalist

Deaf to the Screams. Hundreds of Thousands of Women Are Dying Every Year in Pregnancy and Childbirth, and Nobody Wants to Know

Magazine article New Internationalist

Deaf to the Screams. Hundreds of Thousands of Women Are Dying Every Year in Pregnancy and Childbirth, and Nobody Wants to Know

Article excerpt

Deaf to the screams

THIS IS A STORY of unimaginable suffering. And it is a story that will be inadequately told. For noone who has not experienced what is meant by maternal mortality and morbidity can know the suffering implied. And those who do know are usually silenced - by their early deaths, by their poverty, by their gender, and by the insulating layers of censorship and embarrassment that still surround the issues of sex, blood and birth in most societies of the world.

For a decade the figure of 500,000 maternal deaths a year has been part of the statistical liturgy. In 1996 new estimates are showing that the number of women who die each year in pregnancy and childbirth is probably closer to 600,000.

But before the new estimates replace the old as a way of packaging up the problem, it should be said that a mistake has been made in allowing statistics such as these to slip into easy usage. For these are not deaths like other deaths, and death is only a part of the story they have to tell.

They die, these hundreds of thousands of women whose lives come to an end in their teens and twenties and thirties, in ways that set them apart from the normal run of human experience.

Over 200,000 die of haemorrhaging, violently pumping blood onto the floor of bus or bullock cart or blood - soaked stretcher as their families and friends search in vain for help.

About 75,000 more die from attempting to abort their pregnancy themselves. Some will take drugs or submit to violent massage. Alone or assisted, many choose to insert a sharp object - a straightened coat - hanger, a knitting - needle, or a sharpened stick - through the vagina into the uterus. Some 50,000 women and girls attempt such procedures every day. Most survive, though often with crippling discomfort, pelvic inflammatory disease, and a continuing foul discharge. And some do not survive: with punctured uterus and infected wound, they die in pain and alone, bleeding and frightened and ashamed.

Perhaps 75,000 more die with brain and kidney damage in the convulsions of eclampsia, a dangerous condition that can arise in late pregnancy and has been described by a survivor as 'the worst feeling in the world that can possibly be imagined'.

Another 100,000 die of sepsis, the bloodstream poisoned by a rising infection from an unhealed uterus or from retained pieces of placenta, bringing fever and hallucinations and appalling pain.

Smaller but still significant numbers die of an anaemia so severe that the muscles of the heart fail. And as many as 40,000 a year die of obstructed labour - days of futile contractions repeatedly grinding down the skull of an already asphyxiated baby onto the soft tissues of a pelvis that is just too small.

In the 1990s so far, three million young women have died in one or more of these ways. And they continue to die at the rate of 1,600 every day, yesterday and today and tomorrow.

For the most part, these are the deaths not of the ill or of the very old or of the very young, but of healthy women in the prime of their lives upon whom both young and old may depend.

But the numbers of the dead alone do not reveal the full scale of this tragedy. For every woman who dies, approximately 30 more incur injuries, infections, and disabilities which are usually untreated and unspoken of, and which are often humiliating and painful, debilitating and lifelong.

It is part of the silence that has for so long surrounded the issue of maternal morbidity that there is so little research into its prevalence. But based on a few studies and many assumptions, the best estimate that can be made puts the ratio of injuries to deaths at about 30 to 1.

This means that at least 12 million women a year sustain the kind of damage in pregnancy and childbirth that will have a profound effect on their lives. And even allowing for the fact that some women will suffer such injuries more than once during their child - bearing years, the cumulative total of those affected can be conservatively estimated at some 300 million, or more than a quarter of the adult women now alive in the developing world. …

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