Excessive hazards of pregnancy and child birth in the third world.

The National Conference on Safe Motherhood in 1987 established the goal of reducing maternal mortality by 50% by the year 2000. At that time, there were 500,000 deaths from maternal causes, of which all but about 4000 occurred in developing countries. 87% of births globally occurred in developing countries. Maternal mortality was highest in Africa, particularly in Western, Central, and Eastern Africa. The average risk of dying from pregnancy related causes in Africa was over 1 in 20 compared to the 1 in 2000 risk in developed countries. In southern Asia there were 29% of the world's births, but about 50% of the world's maternal deaths. African maternal mortality could reach 1000/100,000 live births in rural areas and 500/100,000 in some cities, while in rural Bangladesh the figures were 600/100,000 and in rural Andhra Pradesh, India, 874/100,000 in 1984-85. The ratios in remote rural areas of China were 200/100,000; the ratios could be as high as 700/100,000 in some areas of Southeastern and Western Asia. In Latin America, the average was 200/100,000 without consideration of underreporting which was estimated at the highest at 60%. In the developed countries of Europe, maternal mortality averaged 10/100,000 or lower; a high value could be 30/100,000. Because fertility was low in developed countries, the actual numbers were 4000-5000 or 1% of the total. Global risks declined by about 5%, but births have increased by 7%. In developed countries, the maternal mortality ratio declined by 13%. Some evidence of decline was apparent in Asia, except for East Asia, and in Latin America. Little progress has been made in improving maternal mortality when the African lifetime risk of dying from pregnancy-related causes was 1 in 20 and a woman's risk in a developed country was 1 in 2000.