Thursday, January 22, 2009

Quiz answers!

Sorry for the delay in the quiz answers - my internet at home has become achingly slow, and it's hard to motivate myself to wait minutes for pages to load. I was also offline for several days, because a few of my classmates and I went to the inauguration. It was a fantastic (if cold) experience! We were waaaay back on the Mall, to one side of the Washington Monument, but we were with a huge and enthusiastic crowd and able to see and hear the jumbotrons very well. I am so excited and optimistic about President Obama, and (to bring it back to our theme) I hope that he is able to bring change to our health care system. Our system is not built to ensure that everyone, including pregnant women and babies, gets the care they need. I believe that once we build that system, a midwifery-led model of care for pregnancy and birth will be the most efficient and safest way to go for care in pregnancy and birth.

So here are our answers to the quiz. My two participants got very close. (I might have made this one too easy again, but the only way to make it harder is to include a lot more countries and that didn't sound fun for anyone.)

Country: maternal mortality ratio (lifetime risk of maternal death*)
U.S.: 11/100,000 (1 in 4,800)
Sweden: 3/100,000 (1 in 17,400)
Ukraine: 18/100,0000 (1 in 5,200)
Afghanistan: 1,800/100,000 (1 in 8)
Canada: 7/100,000 (1 in 11,000)
Nepal: 830/100,000 (1 in 31)

*This is the chance that a woman will die of pregnancy-related causes; it's affected by both the maternal mortality ratio and the fertility of the population overall. A population where women have lots of babies will have a higher lifetime risk, because they are at more risk with more pregnancies.

Some observations: the U.S. does not do terribly in this list, but there are a lot of countries who outrank us. Sweden is an example of a country which achieves very low maternal mortality ratio with a midwifery-led model of care. Afghanistan is more or less the country with the highest maternal mortality in the world. Nepal's maternal mortality ratio is very high, but about the same as the estimated ratio for the U.S. in 1900 (850/100,000); change is possible, although it doesn't have to take a century.

All of these numbers are from 2005, according to my notes, although you'll find slightly different numbers depending on where you look (UN, WHO, individual countries' reports).

To spin off a small different topic on this theme: my class had a lecture on cesarean sections on Tuesday from someone who works for the Averting Maternal Death & Disability project. C-sections have a paradoxical role in maternal mortality. Many women in the developing world die from lack of c-section availability; others die from c-section complications. Some women in the developed world die from unnecessary c-sections, or from c-section complications that also could be avoided. How do we strike a balance, make cesareans safer, and know when we're doing too many? One interesting item she shared was that in studies of cesarean increases in developing countries, researchers found that the risks for a population began to outweigh the benefits at some point during the period where c-sections rose from 10% to 20% of the population. This is in line with the WHO guidelines of 10-15% established in the 1980s although (according to our speaker) being questioned today (both by those who think the threshold should be higher and lower).

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