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Maternal mortality: it’s time to get political
Author(s) -
Weeks A
Publication year - 2007
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2006.01185.x
Subject(s) - health care , gross domestic product , developing country , politics , medicine , quality (philosophy) , economic growth , political science , economics , law , philosophy , epistemology
Nigeria has the 47th highest gross domestic product (GDP) worldwide and is the worlds 8th largest exporter of petroleum. It has a maternal mortality ratio (MMR) of 800/100 000 live births. In contrast Sri Lanka is 78th on the GDP list but has an MMR of only 92. Among the wealthy countries Sweden has the 20th highest GDP and a MMR of 2 while USA despite being the richest country in the world has a MMR of 17. If we are to reduce maternal mortality worldwide it is crucial that we understand the reasons for the wide variation in MMRs. One would expect that the MMR would correlate with the prevalence of major complications of pregnancy but such complications occur in a remarkably constant 15% or so of pregnancies throughout the world. Nor does the MMR correlate well with a countrys wealth as the examples above show. What is however highly predictive of a countrys MMR is the quality of its health services. Comparing each countrys MMR and healthcare quality (as defined in the World Health Organization World Health Report of 2000) shows the two to be closely correlated. Quality of health care is used here in its holistic sense--not just as a measure of the best the country can provide in its large teaching hospitals and private clinics but how effectively good quality health care reaches the countrys poorest in rural areas well away from the capital. It also takes into account the health services effect on the nations health the way the health workers treat individuals on a personal level (as regards dignity confidentiality and client orientation) and the fairness of financial contributions. (excerpt)