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Childbirth risk never too far away
The Australian - November 8, 2008
Kevin McCracken – Recently Time magazine (September 29) carried a major story on the continuing problem of women dying in childbirth in poor countries around the world, reporting how, despite a range of medical breakthroughs over the past 20 years, the "ratio of maternal deaths to babies born has barely budged in poor countries". The cases of Sierra Leone and Afghanistan, where a woman's lifetime risk of dying from maternal causes is 1 in 8, were highlighted.
A variety of other poor countries could just as easily have been chosen to make the same point. In Niger, women stand a 1 in 7 lifetime chance of dying in childbirth, while in Chad the ratio is 1 in 11, and Angola, Liberia, Somalia it is 1 in 12. The attention drawn to such appallingly high continuing levels of loss will hopefully spur intensified efforts to reduce the tragic toll.
One of the dangers though is that many Australian readers of Time will mentally pigeon-hole the deaths of women in childbirth as a problem of faraway and less-developed countries, and something not really all that relevant to our part of the world.
However, if we look around our own regional backyard we will find that in quite a few of our neighbours, childbirth is still a very risky business. The two standouts in the region are countries which both share closely intertwined political histories with Australia – East Timor and Papua New Guinea.
The latest UN/World Bank estimate of maternal mortality in East Timor is that current annual deaths from childbirth, in conjunction with the country's fertility rate, place women at a 1 in 35 lifetime chance of dying in this manner. In Papua New Guinea the combination of present childbirth mortality and fertility rates adds up to a 1 in 55 chance. While they are the standouts, those two countries are by no means the only areas of concern in the region.
Solomons Islands women, for example, bear a 1 in 100 lifetime chance of dying in childbirth, and Fijian women, 1 in 160.
Although these figures are thankfully well removed from the levels found in Afghanistan and many African nations, they should cause us all concern at the human suffering they represent sitting literally on our doorstep – particularly when the comparable Australian lifetime risk of 1 in around 13,000 is considered.
In all cases the high toll derives from an interrelated constellation of poverty, low educational levels, poor living conditions, inadequate government health expenditures, shortages of skilled health workers, limited health infrastructure, gender inequality, political instability and the like. In the PNG case, the situation is exacerbated by the difficulties of servicing populations widely dispersed across the country's extremely rugged terrain.
The above, though, are just part of a wider problematic health scene in many of our regional neighbours. We hear a bit about this most years at the time of the annual Pacific Islands Forum, but other than that health issues across the region do not attract great attention. Yet bubbling away in many of the island states are health problems of profound personal and national significance.
Quietly working its way through the region is an epidemic of lifestyle-related diseases – diabetes, heart disease, stroke and cancer – propelled by poor diet, obesity, smoking and alcohol abuse.
While tourist brochures may portray the image of slim, healthy islanders the reality in many of the countries is very different. Obesity levels have reached crisis levels in a range of states across the region. For example, on Nauru over 80 per cent of the population is estimated to be obese on the widely used BMI scale. For the Cook Islands the estimate is three-quarters of the population, and on Tonga it is judged to be over 70 per cent.
Largely responsible for these figures is a nutritional transition away from traditional diets of fish, vegetables and fruit to a dominance of imported fatty and sugary processed foods. Clever marketing has brought about a change in people's preferred food tastes to favour imported Western-style items, with Australia and New Zealand up there amongst the leading suppliers of these poor-quality foodstuffs. Population increase and growing urbanisation are other contributory factors to the transition. Complementing these processes has been a shift to less physically active lifestyles. Hand-in-hand with this transition has come the emerging non-communicable disease burden mentioned above – diabetes, heart disease, stroke and cancer. The first of these, diabetes, is rapidly becoming an especially insidious challenge to the region.
Alongside new problems such as obesity and diabetes, a significant number of countries in the region also continue to suffer major old-style health afflictions like malaria and tuberculosis. Recently released WHO estimates of TB prevalence for instance placed four of the region's nations in the worst-afflicted 20 per cent of countries in the world – East Timor (789 sufferers per 100,000 population), Papua New Guinea (513), Tuvalu (504), and Kiribati (402).
We don't, therefore, have to look too far offshore to find neighbouring states with enormous health problems that should concern us.
[Kevin McCracken is dean of environmental and life sciences at Macquarie University.]
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