It turns out that a lot of things depend on where you live in the world. Anyone born in a country with a stable economy and good social services should consider themselves lucky. We might like to think that it’s our own individual efforts that give us a better life, but it turns out that these may depend highly on arbitrary things such as location, local policies, culture and a bunch of other things.
And one’s luck may also depend on where, exactly, in your particular country you are. This is particularly true for places where inequality is rampant, places in “developed” countries where things such as poverty and health care outcomes are not much better than those of the average developing country.
Among the things that are affected significantly are maternal and child health. This basically means that, in some places in the world, it is much better and safer to have a baby than in others. Some of the best places in the world include Canada, Australia and many parts of Europe. But this also means that some places are worse off.
Today, we’ll look into fifteen regions or countries that aren’t exactly the ideal places to have a baby. We’ll talk a little bit about what it is, exactly, that makes it unideal to have a baby there. Note that we’ll be discussing several measures, including maternal mortality, infant mortality, maternity leave, culture and access to health care, all of which can have an impact on each individual mom’s pregnancy and childbirth.
15 South Korea
Another country in which it's difficult to be a mom is Korea.We’re talking about South Korea as no reliable data is available for North Korea. Now, this is not because of the standard measures. By large, Korean mothers have pretty good outcomes in maternal and child survival, putting them at par with Japan and some countries in Europe. There are, however, cultural barriers that make motherhood difficult for Korean moms.
For one thing, pain meds are frowned upon. Having to take them is culturally perceived as a sign of weakness. Those who opt for pain meds are often admonished and perceived as unlikely to become good mothers. Which is probably great for those with a high tolerance to pain. But those with low pain tolerance who are otherwise good moms might suffer. As well, the episiotomy rate is high, and we all know how incredibly painful episiotomies are with anesthesia, let alone without it.
Among the so-called developed countries, the United States has the worst markers for maternal health. This is not because health care here is poor, although the quality does vary from state to state. The main reason is inequality. Mothers who are economically disadvantaged or who live far from the nearest hospital may not have as much access to health care as mothers who are better off.
Another contributing factor is the number of teenage mothers, considering the fact that many women lack access (sometimes due to lack of proximity, sometimes due to local culture) to birth control. As such, the United States has among the highest teenage pregnancy rates, which are inherently high-risk. All these have contributed to the fact that the U.S. has the second highest rate of preterm births among all the developed countries. This is not to mention the fact that there are no federal laws for compensated maternal leave. A mom’s ability to sustain herself and her child while working depend largely on state laws.
In Pakistan, maternal mortality rate is quite high due to poverty and lack of education. In addition, there are remote communities that are not able to access the best health care in the country, which can be found in cities. As such, many women do not get adequate prenatal care and, in the case of any emergencies, they will not be able to get to a hospital quickly.
Yet another problem that women in Pakistan have is that early marriages are common. This is particularly in rural areas where women have limited access to education and equal job opportunities, and therefore may have to be married off early, essentially becoming dependent on their husbands. In fact, some statistics state that a third of women are married off before they turn fifteen. If a woman refrains from having children until she’s in her twenties, this could be fine, but those who get pregnant in their teens are at high risk.
While maternal and child health in Nepal is improving, there are still some major problems to look over. For instance, there is a large disparity in the access of health care in urban and rural communities. The majority of women who live in cities – almost about eighty percent – have access to quality health care. In far-off provinces, however, only one in every three women are able to get basic maternal health care services.
As a whole, only about four in every ten women in Nepal have access to a skilled maternal health care provider such as a doctor, nurse or midwife. In some places, women are attended to by traditional practitioners, who if untrained may use crude, unsterilized instruments during childbirth, amping up the risk for infection and hemorrhage. Almost half of maternal deaths in Nepal are caused by postpartum hemorrhage, which is tragic, since this is so easily preventable.
In the nearby country of India, the situation is the same. Health care is improving, but is largely unequal. In fact, data from the organization Save the Children lists India as among the countries with the highest rates of first-day deaths, meaning that a large number of babies born in India die on their first day. And just like in Nepal and Pakistan, quality health care is often more accessible for women who live in cities. Women who live in remote areas, therefore, are at higher risk.
The problem is not that the country is poor. In fact, it’s improved economically in the past years. According to Time magazine, it has become much richer than its neighbor, Bangladesh, in the past years. However, Bangladesh has surpassed India in terms of maternal and child health indicators. The difference? Bangladesh has invested far more resources into health care services. If India manages to get this kind of service to her people, there may very well be a marked improvement!
Yet another country where inequality is rampant is the Philippines. Moms in the cities have access to quality health care, yet those in remote areas, predominantly cultural minorities, do not have it as easy. It does not help, either, that many women in these areas do not have access to birth control. As such, they are prone to getting pregnant often, sometimes with little gap between children.
Because of these compounding issues, the population of the Philippines is growing rapidly, but primarily in families who don’t have much access to health care and with lower income. Things might improve drastically if the country invested more money in making quality health services accessible in rural areas, as well as making birth control accessible to those who want it. As it is, however, many Filipino women die each year from causes that are otherwise preventable, some of the biggest culprits being postpartum hemorrhage and preeclampsia.
While Myanmar’s maternal mortality rates are going down, it is doing so at a slow pace. The most common cause of maternal mortality here is still postpartum hemorrhage, again a preventable cause. As well, Myanmar also has a high rate of babies born with low birth weight, which experts attribute to malnutrition and poverty.
Again, this also has a lot to do with inequality. Mothers in remote provinces are more likely to have low-birth weight children, as well as suffer from pregnancy-related complications, compared to moms in the cities. Only a quarter of childbirths in rural areas are done in safe health care facilities, whereas the number is 65 percent in cities. Like so many other places, it all boils down to access to quality health care. In addition, internally displaced persons due to the conflict in the Rakhine state suffer from economic and social instability, making it difficult for them to access health care.
Peru’s maternal mortality rates have always been extremely high. In the recent years, however, they have been steadily decreasing, putting their markers at par with countries such as Russia and China, which aren’t the best, but aren’t the worst either. But this improvement is largely unequal. In poor, rural areas, maternal mortality rates are just about as high as before. At particular risk are indigenous Peruvians, many of whom were pushed to the fringes following Spanish colonization.
As well, Peru has one of the highest rates of domestic violence in the world. While domestic violence is illegal in Peru, numerous cases are still recorded each year. A report by the World Health Organization even estimates that up to 69 percent of women in the country have experienced physical violence at some point in their lives. We can agree that this kind of environment is not exactly conducive for becoming a mom and raising kids.
7 Papua New Guinea
Papua New Guinea is yet another country with high maternal mortality rates. Hospitals and rural health clinics are often crowded, and women often suffer from complications related to pregnancy and childbirth. One of the major reasons why this is so is that the country has only an incredibly small medical workforce, with numbers as low as 0.06 physicians per 100,000 people. Midwives and nurses are scarce as well. While the situation is improving, progress is quite slow.
But one of the major factors why maternal health outcomes are so poor is because, like the United States, there are no laws guaranteeing paid maternity leave to all women. PNG has taken strides to correct this. It currently offers maternity leave for civil servants, but for other women, there are no guarantees. The absence of such a policy can make it extremely difficult for women to maintain jobs and to help sustain their families.
Located smack in the middle of the Caribbean, Haiti has among the highest maternal mortality and under-five mortality rates in the world. Poverty is rampant, and the average Haitian woman has only eight years of formal education on average.
Maternal health outcomes in Haiti are dismal partially because the country is politically unstable, but also because it has been battered by natural disasters such as typhoons over the years, plus the huge 2010 earthquake. As well, women there fight desperately for their rights, considering how rampant sexism and domestic violence is. It’s also an example of how governance and corruption significantly affects health care outcomes. The neighboring Dominican Republic, which practically shares that same island as Haiti, scores significantly better than Haiti. In the 16th annual State of the World’s Mothers report, Haiti ranked a low 169 out of 179 countries, whereas the Dominican Republic is a long way off at 95!
Over the years, Afghanistan has had tragic rates of maternal and child mortality. This was due largely to the effects of the Taliban regime from 1996 to 2001. The Taliban created policies that restricted women’s access to proper health care causing a drastic dip in health care outcomes. This is not to mention the damage caused by war to medical infrastructure in areas affected by armed conflict. Additionally, many health care professionals fled the country as refugees in the midst of violence. Even now, some conservative Taliban-influenced families still consider the provision of maternal health care as “dirty.”
There is a ray of hope, however. Most of the causes of maternal mortality are preventable. With the help of a national midwifery program, the country hopes to lower its maternal mortality rates by increasing access to care. But the country also needs to address its high rates of child mortality, which is the fourth highest in the world.
4 East Timor
The relatively young country of Timor Leste has among the highest rates of infant mortality in Asia, and its maternal mortality rates are pretty bad as well. This has plenty to do with the country’s long conflict with Indonesia, which has caused limited access to health care and an extremely unstable life for the people there. While Indonesia, itself, is also struggling with its infant and maternal mortality rates, the ravaged Timor Leste’s rates fall way below it.
A major factor to this is that many women still lack access to medical care. Most childbirths occur at home without trained health professionals and clean supplies. Women who experience complications must be brought to hospitals that may be far away. Unpaved roads can prevent their journey from going smoothly. Even in medical facilities, supplies can sometimes be scarce. This can also make things pretty bad for children, who also frequently die of treatable illnesses such as diarrhea.
Guatemala, in the meantime, holds some of the worst maternal and child health care outcomes in Central America, possibly even in all of Latin America. Once the heart of the legendary Mayan civilization, the country has been battered by colonialism and civil war. With currently weak political will when it comes to health programs, many women have difficulty accessing or affording medical care.
Another issue is that very young pregnancies in girls below the age of fifteen are rampant. This is largely because of a conservative hold over reproductive health, as well as an extremely patriarchal society. This promotes an attitude that largely objectifies girls and women, making them prone to sexual abuse. The perpetrators are usually family members. In fact, one out of four of all reported cases of sexual abuse in the country involve a father abusing his daughter. Many cases, however, go unreported as the abuser is often the breadwinner of the family, and putting them in prison would mean that the family starves.
2 Central Africa
While Central Africa is composed of several different countries, we lumped them together here as some of the countries collectively have some of the poorest maternal and child care outcomes in the world. The countries of Chad, the Central African Republic and the Democratic Republic of Congo, in particular, have extremely low rankings in the 16th annual State of the World's Mothers report, with CAR and DRC pretty much almost at the bottom of the list.
As well, the country of Chad has the highest maternal mortality rate in the world, with an alarming 1 in every fifteen women dying of maternal causes, many of them preventable. This is primarily due to long-term political instability and rampant conflict. In addition, there are cultural practices that encourage forced marriages for young girls and high rates of domestic violence. Malnutrition, particularly in poor rural areas, further drives health care outcomes down.
1 Western Africa
Like Central Africa, many of the countries in Western Africa performed poorly on the 16th Annual State of the World's Mothers report. Mali, Niger, Cote d’Ivoire, Nigeria, Sierra Leone, Niger, Guinea-Bissau and Liberia all make it in the bottom ten countries on the list. As with Central Africa, these countries have a long history of political instability, as well as frequent rebellions and tribal conflicts, all of which have hindered progress for generations.
Forced marriages and malnutrition are both also rampant. Many childbirths take place at home without a trained health professional in assistance. This also means that children may not get the vaccines they need, making them prone to getting, and sometimes even dying of, vaccine-preventable illnesses such as measles, mumps and rubella. As well, women in Western African countries often get less than ten years of formal education on average, mostly due to marrying early.