Saving Mothers, Saving Children: The 2008 Mother’s Report

by Marianne Taflinger
– USA –

In Sweden, a doctor delivers Sari, and her family celebrates what will be the beginning of a long life, probably 83 years or more. She’ll attend at least 17 years of school and if she chooses to have children, they’ll be born when she wants them to be born, thanks to convenient and cheap contraceptives. If she has a baby, she’ll take off 15 weeks of work and still earn 80% of her salary. Sari is virtually guaranteed to make it to age 5 without any health complications and enroll in secondary school. Swedish society provides great health care and education that eases both mothers’ and girls’ lives.

By contrast, Adame will live a far more perilous life. Having been born in Niger, she has a high probability of dying before age 5. Like two thirds of all children born in Niger, no “skilled birth attendant” was present at her delivery. It’s likely that Adame will attend only 3 grades in school, and that she will die by age 45, living a life half as long than if she had been born in Sweden. Adame’s mother is practically guaranteed to lose at least one child and has a nine out of ten probability that she will lose 2 children in her lifetime. Due to the lack of contraception, Adame will likely have more siblings than her family can afford. And there’s a strong chance that Adame will suffer from malnutrition and lack a sufficient supply of water.

Why should we think about these stark differences between the developing and the developed world on Mother’s Day? Because the quality of mothers’ lives depends on where they live, whether they have health care and whether they have money or not. And how well mothers fare determines whether their children survive or perish. For the last nine years, Save the Children, an international humanitarian organization, issues a Mother’s Report which ranks the best and worst places to be a mother. This index considers factors such as health, nutrition, education, economic status and political status for women. Out of 146 countries, Sweden, Norway and Iceland are the best three places in the world to be a mother, and Niger is at the bottom. Of 55 developing countries, the top 3 are the Philippines, Peru, and South Africa, with India and Turkmenistan tied for fourth place, while Ethiopia and Somalia are at the bottom.

Social Policies Matter

The dramatic improvement in health outcomes in Sweden since 1920 shows how good social policy saves and extends lives for mothers and their children. In the 1920s poor children in Sweden were 3.5 times more likely to die under the age of 1 year than children of wealthy parents. In the 1930s, Sweden instituted free maternal and child health care and programs to provide financial assistance to lower-income families. Now in 2008, infant mortality is virtually zero.

Through focused social interventions, the Philippines succeeded in reducing deaths for children under 5 by 48% since 1990. But the survival gap between the rich and the poor has increased by 18% since that time. With a partnership between US AID and the Department of Health, the Philippines has achieved a 92% immunization rate for measles for 1 year olds, and oral rehydration treatments are used with ¾ of the children affected by diarrhea. It now has the lowest mortality rate among developing countries, and a high rate of deliveries with skilled birth attendants (nearly 60% of poor children versus 92% for the wealthy). So, while there has been substantial progress, even in the “best places” disparities still exist between the rich and poor. If health care services were as available for poor children as they are to rich children, there would be 26,000 more Philippine children who survive every year.

The Mother’s Report is one part of the 2008 State of the World Report, which reports the “child survival gap” between rich and poor countries and within countries. Worldwide, 200,000 children under age 5, virtually all of them in the developing world (83%), receive no basic health care. This lack of service causes 10 million deaths annually. 26,000 children die every day from completely treatable conditions such as diarrhea, pneumonia, malaria and measles. Pneumonia kills more children under age 5 than AIDS, malaria and measles combined. Yet, it can be cured for 30¢ a dose. For a mere 50¢ a dose, diarrhea can be cured through oral rehydration therapy consisting of salt, sugar and potassium. For 33¢ a dose, measles can be cured, and yet 30% of children under 1 year are not immunized in the countries that account for 95% of the deaths. Malaria kills 800,000 children in Sub-Saharan Africa, and though these deaths could also be prevented for a mere $2.80-$4.00 for insecticide spraying and bed nets, only 8% of children under 5 sleep beneath them.

Save the Children’s message is that we could save 6 million children a year if disparities in health care were eliminated. Increases should be made to health care funding and spent where diseases are the most prevalent. By training community health care workers to administer simple treatments, health care would become more accessible to rural and urban poor people. An added 3.9 million more children would survive to age 5, if more community health workers were trained to intervene.

But the story of health inequities for mothers and their children is not just a story for the developing world. The United States actually ranks 27th on the Mother’s Index , dropping from 26th last year, due to high maternal mortality rates, high poverty rates (relative to other developed countries), low enrollment of children in preschool, and low female participation in the political process (representatives in Congress). The startling inequities in health belie our “social melting pot” belief. In the United States, one child in five lives in poverty, but 40% of African American, 39% of Native American and 30% of Hispanic children are poor, compared to 16% of white children. African-American children are also 2.4 times more likely to die than white children; their mothers are 3.7 times more likely to die during childbirth than white mothers.

The story that the numbers tell us is simple. Being poor increases the risks of dying at birth, of dying in the first five years of life, and of dying during childbirth. If a child survives to age 5, the odds are good that she will live a full life. If mothers die, the chances for her child’s death skyrocket. As a mother becomes more educated, her child’s survival rate soars, as does the length of her life. Effective treatments for the under-treated diseases of pneumonia, malaria and diabetes are astoundingly simple and low-cost (.30-$4.00 per dose) when treated early. Positive social policy strikingly improves children’s and mothers’ survival rates. Putting more money toward helping the poorest mothers in the world has extraordinary impact upon the quality of their lives and that of their children. Training poor people to administer a few simple treatments as community health workers could save the lives of millions of children. (In villages where a trained community health care worker exists, infant mortality drops by 90%.)

Every day mothers grieve the loss of 26,000 children, but it doesn’t have to be this way. There’s currently a bill before Congress entitled the U.S. Commitment to Global Child Survival that is designed to implement these protective strategies for mothers and children. With awareness, political will, and a unified effort between government, nonprofits and the communities themselves, the lives of mothers and their children can improve. But, it’s up to us to see that it happens.

About the Author
As an editor of psychology and special education books, Marianne Taflinger was vitally interested in the alleviation of human suffering, which led to her enrolling in a Master’s of Public Administration program in international development at the Monterey Institute of International Studies. While at MIIS, Marianne has worked with Second Chance Youth Program in writing a grant that was awarded $300,000 from the California Wellness Foundation, worked on a Community Assets Mapping project managed by the University of California-Davis, and researched the developed world health inequities for Save the Children in the State of the World 2008, where the Mother Index appears.