Maternal Mortality Rates Are 27 Times Higher Globally Than In Europe. Why That Is A Good Thing

The chart below is based on maternal mortality rates, the number of women per 100,000 who die from pregnancy-related causes in a year. The first bar shows how many women die each year, while the second bar shows how many would die if they had Europe's living standards. What conclusions would you draw?

The global rate is 216, while the European rate is 8. The global rate is 27 times higher! About 290,000 women die each year because they do not have the living standards of the most affluent countries.

I would hope this would spark a sense of injustice. Something is wrong with a system that creates such a disparity in outcomes. Surely, we must upend this inequitable system and replace it with something just.

Now look at the second chart. What conclusions would you draw?

Before 1800, the global maternal mortality rate was 900. Today it is 216! It has dropped by 75%. By historical standards, this borders on miraculous. Something is right about a system that radically improves human well-being. How can we preserve and extend the improvement? (Note: The global rate dropped steadily from 385 in 1990 to 216 in 2015. The trajectory continues rapidly downward.)

A holistic view of human well-being will consider this chart, including all three bars.

Some observations.

First, we would have a more equitable maternal mortality rate without the systems that developed over the past two centuries. No place on earth would have a rate of eight deaths OR 216 deaths. We would still have a very equitable world of 900 deaths. Is that "equality" preferable to today's eight vs. 216 inequality? I do not think many would agree. The eight vs. 216 differential is good relative to the historical alternative.

Second, that some locales have a rate of eight, points to the possibility of a world where this level of well-being spans the globe. Justice requires that we pursue this equitable outcome. We must look back to understand what brought us to where we are and be discerning about obstacles blocking this objective going forward.

Third, I am using maternal mortality rates as a symbol of broader improvement in human well-being in recent generations, sometimes called the Great Divergence. Appreciating this significant divergence from human history neither requires us, in some consequentialist way, to a) embrace all that has developed in the past couple of centuries nor b) to refrain from asking rigorous questions about justice going forward. There have been profound injustices and inequities in the past two centuries. There are today. And yet, the Great Divergence happened, and it continues. Lack of historical context and blindness to trajectories can lead us to snap-shot-in-time views that inspire us to well-intentioned but destructive actions, destroying good in the process. Keep what works and adjust with discernment. Neither revolution nor complacency will do.

Comments

[Ruth Ann Aufrecht]

I don't see where this data compares midwife-oriented and home birth care versus physician and hospital birth care. In the United States, I believe modern hospital delivery protocols increase maternal and infant mortality rates using their lack of evidence-based care. If we had more midwives who were with the woman during pregnancy and delivery, I believe we would have better outcomes, like Finland and Sweden.

https://www.washingtonpost.com/outlook/2019/01/16/lower-maternal-infant-mortality-rates-we-must-bring-back-midwives/