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Childbirth risks linked to poverty

NEW YORK — A new study ranking 133 countries found that women in Africa and other poor nations die in pregnancy or childbirth at a rate 33 times higher than women in Europe, the United States and other rich nations.

Despite what many international health experts consider signs of progress for women's health in recent decades — a more than tenfold increase in global contraceptive use and a sharp decline in family size — more than a quarter of pregnant women in sub-Saharan Africa still receive no prenatal care and nearly half deliver babies with no help from skilled health personnel, the study found.

"There is a gaping chasm between rich and poor countries when it comes to the sexual and reproductive health of women," said Amy Coen, president of Population Action International, an independent research and advocacy group for population programs.

"Right now, in developing countries . . . there are 150 million women who say they want to prevent or delay their next pregnancy, yet do not have access to contraceptives," she said.

The organization's study, released Wednesday on the eve of International Women's Day, ranked 91 developing countries and 42 developed countries representing 95 percent of the world's population on a reproductive risk index. It used 10 indicators — including births to teens and women, contraceptive use, and abortion policies — to rank the countries in one of five risk categories: very high, high, moderate, low or very low.

The 10 highest risk countries were Ethiopia, Angola, Chad, Afghanistan, Central African Republic, Mali, Niger, Congo, Sierra Leone and Lesotho. The 10 lowest risk countries were Italy, Sweden, Finland, Singapore, the Netherlands, Germany, Belgium, Norway, Denmark and Australia.

While the United States was in the very low risk category, it ranked 15th — below Singapore and just above the Czech Republic and Lithuania.

Coen said the key reason for the low U.S. ranking is that the United States has more teenage mothers than any other industrialized country.

"If you look at countries ahead of us — they make a commitment to young people that the United States simply hasn't made," she told an audio news conference, explaining that they provide more intensive education "from cradle to adulthood" on reproductive and sexual health along with services when requested.

But the risks for American women are far less than those faced by women in developing countries.

According to the study, one in every 65 women in developing countries will die from reproductive health-related causes during her lifetime, a rate 33 times higher than the risk to women in developed countries who face a one in 2,125 chance of dying.

New estimates suggest that 515,000 women die each year in pregnancy and childbirth, or almost one death every minute, and millions more become ill or disabled, Population Action International said.

Births to teen-age girls — associated with higher death and disability rates than births to older women — are highest in Angola, Niger, Congo, Liberia and Sierra Leone, where one in five girls aged 15 to 19 give birth each year, the organization said.

By comparison, teen birthrates are lowest in Japan, North Korea, South Korea, the Netherlands and Switzerland, at fewer than one in 100, it said. In the United States, one in 20 teen-age girls give birth each year.

The report called on the 179 governments who adopted the program of action at the 1994 U.N. population conference in Cairo to honor their commitment to spend $17 billion annually to achieve universal access to basic reproductive health services.

"Reproductive health care is as essential as antibiotics and immunizations to protecting the health of women and children," said Maurice Middleberg, director of the health and population unit at CARE, an international relief organization.