Access to Health Care in Pregnancy and Childbirth

The Reproductive Risk Index scores countries separately on the percentage of women receiving prenatal care and the percentage of births attended by skilled personnel at delivery. Afghanistan ranks last on both indicators, with just 8 percent of women receiving trained care in either pregnancy or childbirth. In 42 of the countries included in this study, fewer than 75 percent of women receive care during pregnancy. In 58 countries, less than 75 percent of deliveries are attended by skilled personnel. Except for Sri Lanka, South Asian countries have particularly low rates of skilled attendance at delivery, rates similar to those in East, West

Worldwide, 210 million women become pregnant each year and around one-quarter of pregnant women develop complications. More than one pregnancy in 350 is fatal. Life-threatening complications of pregnancy and delivery cause more than three-quarters of maternal deaths, and contribute substantially to infant deaths and ill health. Around 20 percent of maternal deaths result from indirect causes including anemia and infectious diseases, which can be addressed through antenatal care. In the developing world, significantly lower proportions of newborns whose mothers die in childbirth survive to their first birthdays.

Adequate care during pregnancy and especially at labor and delivery are the most cost-effective interventions for improving maternal and newborn health, according to the World Bank. Such interventions could prevent the majority of perinatal, infant, and maternal deaths and disabilities. Yet in the developing world some 45 million women do not receive prenatal care and 60 million births take place in the absence of skilled attendants.

Deaths from Reproductive Health Causes
Cause of death	Total annual deaths among adults (aged 15 and above)	Percent of annual deaths in developing countries	Percent of annual deaths in developed countries
HIV/AIDS*	2,500,000	99%	1%
STIs (Syphilis, Chlamydia, & Gonorrhoea)	178,000	99%	1%
Cervical cancer	237,000	85%	Pregnancy and childbirth

*Includes both sexual transmission and non-sexual transmission. However, non-sexual transmission represents a small proportion of total infections.
Sources: UNAIDS and WHO

Deaths due to reproductive health-related causes cut short the productive lives of men and women, undermining economic development in the world's poorest countries. Yet these deaths are largely preventable and could be averted with such cost-effective interventions as improving access to maternity care and family planning services, including male and female condoms for prevention of HIV and other sexual infections.

It costs around $20 to $25 each year, on average, to provide basic family planning services to one person in a developing country. Another $10 per client would provide access to drugs to prevent internal bleeding, birthing kits, and post-abortion care technologies. And detection and treatment of a wide range of STIs would cost less than $30 per client in most developing countries. Even these interventions, however, would dwarf the health budgets of many developing countries.