On February 12, the United Nations Population Fund released a major report on the progress the international community has made in regards to improvements in women’s health and equality. Women are having fewer children, many maternal mortality rates have gone down and literacy rates have gone up. While these are resounding achievements, the report concludes that “women’s status, maternal death, child marriage…have seen little progress in the last 20 years” in the poorest areas of the world.
Maternal mortality is unacceptably high. Worldwide, approximately 1,000 women die from pregnancy or childbirth related complications every day. 99% of these deaths occur in developing countries. The immediate causes may be complications such as eclampsia, hemorrhage, malaria, abortion complications, obstructed labor or sepsis; however, there many other factors that are responsible for these high death rates.
One reason women die in childbirth has to do with two of our most basic evolutionary developments – walking upright and having bigger brains. 1.9 million years ago, the pelvis bones of the Homo erectus narrowed to allow early humans to walk upright and run for longer distances. While this ability made running and walking more efficient, it also made childbirth more difficult. In addition, human skull size expanded as our ancestors developed bigger and more complex brains. The brains of human infants are larger compared to their body size and weight than any other animal, and they further complicate childbirth. Humans are consequently the only mammals that need assistance with childbirth.
The lack of education is a major impediment to maternal care. Education is associated with lower family sizes, increased contraception, and increased use of hospitals. Educated families are also more likely to earn a living and be able to afford health care. The World Bank has estimated that “for every one thousand girls who get one additional year of education, two fewer women will die in childbirth.”
The United Nations Population Fund reported that “In conditions of structural poverty, the threats to women’s survival are especially acute, due to the lack of access to health services, particularly sexual and reproductive health services, and the extreme physical burdens of food production, water supply and unpaid labor that fall disproportionately on poor women.”  The lack of access to health care in rural areas is a major impediment to maternal care. Rural areas suffer from a severe shortage of doctors, medicines and adequate equipment.
While there has been significant progress in improving maternal health, maternal mortality rates remain extremely high in impoverished and rural settings. Maternal mortality is fundamentally a human rights issue that can easily be prevented by improving local education and health care systems. As Nicolas Kristof argues, it is “tolerated only because its victims are poor, rural women.”
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