Roundtable

Is pregnancy getting safer for women? It depends. It depends on where a woman is born her social class ethnic group or other marker of social and geographic positioning. While specific changes in medical techniques or fashions may theoretically improve or worsen the risks for individual women everywhere from a public health perspective maternal mortality remains the indicator of population health that reveals most starkly the profound inequities of our time. For decades now estimates of lifetime risk of maternal death have captured the gulf between women in the poorest countries and those in the wealthiest: in sub-Saharan Africa women have a lifetime risk of 1 in 16 of dying in pregnancy and childbirth while in Europe they run a dramatically lower risk of 1 in 2400. Newer techniques use data from Demographic and Health Surveys to estimate disparities within countries between the highest and lowest wealth quintiles with analyses showing as much as a six-fold difference in maternal mortalityratios. There is a critical distinction between countries with massive deprivation (in which the elites have access while the great majority of the population is excluded) and countries with marginal exclusion (in which most of the population has access while only the poorest most disadvantaged are excluded). This distinction helps put the disparity between the highest and lowest quintiles into overall perspective and clarifies the nature of underlying systemic failures - and the very different strategies needed to tackle them. (excerpt)

Economic growth · Economics · Human rights · Political science · Public health · Public relations · Global Health Care Issues · Global Maternal and Child Health · Healthcare Systems and Reforms · Law · Medicine · Nursing

• Power analysis in health policy and systems research

  Open Access•Stephanie M Topp, Marta Schaaf et al.•BMJ Global Health•2021

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• Maternal morbidity

  Open Access•Karen Hardee, Jill Gay et al.•Global Public Health•2012

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• Going to scale with professional skilled care

  Open Access•Marge Koblinsky, Zoë Matthews et al.•The Lancet•2006

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• Maternal mortality

  Open Access•Carine Ronsmans, Warren Graham et al.•The Lancet•2006

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