Badakhshan, a remote and mountainous province in Afghanistan, has the highest rate of maternal mortality in the world: For every 100,000 live births, 6,500 mothers die. About the time that statistic came across my desk, the New York Times ran a picture on its front page—and several more inside—showing the bone-dry hills and rudimentary living conditions in one of Afghanistan’s poorest provinces: Bamian. The Times story was about the hunger looming over one-quarter of the country’s population, and Oxfam’s warning about a potential humanitarian crisis. Drought, an unusually harsh winter, and a lack of security have all contributed to the food shortage.
Studying the bleak landscape in the newspaper pictures, I thought about maternal mortality in Afghanistan–where a woman dies every 27 minutes from pregnancy-related complications–and in other places, too, far from hospitals or clinics, unattended by doctors, nurses, or midwives. Ethiopia was top on my mind, particularly a parched region in the south where families of herders eke out a living with their cattle and goats. A couple of years ago I had a conversation with a man who grew up there: Kote Ibrahim. Tall and intense, he had come to the Oxfam office in Addis Ababa on a mission of urgency. He was starting a local organization to help poor families in the Liben area and he wanted our support. The people of Liben, he said, were starved for basic services like health care—especially women in labor.
“The clinic is 100 kilometers away,” said Ibrahim. “Many of them die along the road.”
If you look at a map of Ethiopia, you won’t find too many paved roads crisscrossing the country. There’s only one that leads from Addis south to the Kenyan border. Many people beyond the urban areas get about on foot, which means the 100 kilometers Ibrahim referred to could translate into days of travel. Carried on stretchers, women with labor complications often don’t make it.
The maternal mortality rate in Ethiopia is less than half of what it is in Afghanistan, where there are 1,600 maternal deaths for every 100,000 live births. And statistically, Badakhshan may be the worst place in the world to give birth. But every labor that ends in death along a dusty track on the way to a distant clinic is just as horrific.
Leaders from around the world are meeting at the United Nations this week to talk about what progress the world has made toward meeting its Millennium Development Goals—a blueprint for fighting global poverty. One of those goals is to reduce by three-quarters the deaths of women during pregnancy and childbirth. The deadline is 2015. We have a long way to go to meet it.