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Education and health: Where do gender differences really matter?
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FIGURE 3.13
Maternal mortality ratios declined steeply in selected countries during 1930–60 large declines in the maternal mortality rate between 1930–60
800
maternal deaths per 100,000 births
there were 63,000, and in Sub-Saharan Africa, 203,000 (56.7 percent of the global total). One of every 14 women in Somalia and Chad will die from causes related to childbirth. As a proportion of all births, more women die in childbirth in India today than did in Sweden at the beginning of the 1900s—and in Liberia today than in Sweden in the 17th century.79 Between 1930 and 1960, the maternal mortality ratio—the risk of death for every birth— fell significantly in developed countries (figure 3.13). The ratio began to drop sharply in the late 1930s in most countries, driven in part by the introduction of sulfa drugs in 1936 and by an increase in the number of institutional births with better care.80 The ratios then converged strongly across countries in the 1940s and 1950s—most countries reached modern levels in the early 1960s; Italy, Japan, and Portugal reached those levels in the mid-1970s. Declines were sharper in the Anglo-Saxon countries relative to the Nordics, which already had low maternal mortality rates in 1935. The United States stands out as the country with the highest maternal mortality ratio for 1900–30, but like the others, sharp declines began around the mid-1930s and fell to current levels by 1960. These declines were brought about largely by simultaneous improvements in the medical system at the point of delivery and in services to pregnant women, and by shifts in expectations of where to deliver––from home to hospital.81 The patterns are fully reflected in changes in excess female mortality in the reproductiveage groups for selected countries (figure 3.14). For these countries, excess female mortality in adulthood remained fairly high until 1930 (with
500
400
200
0 1900
1920
1940
1960
2000
Belgium
Spain
Italy
England and Wales France Japan Norway
Switzerland Denmark Finland
Netherlands Portugal Sweden
Source: Albanesi and Olivetti 2010.
a spike downward coinciding with World War I and a peak in 1918 with the flu epidemic) and then declined sharply to zero between 1930 and 1960.82 The late declines are precisely for countries—Italy, Japan, and Portugal—where maternal mortality rate declines occurred latest. For all countries in 1990–2008 and for highincome countries with historical data, the basic pattern remains similar with higher maternal mortality ratios associated with greater excess
Nobody in this village has access to drinking water. People bring water from a spring and a water pool that are at a 100–1,000 meter distance from the village. Those also dry out during some seasons and the children and especially the girls spend more than five hours daily to bring water. . . . Between the neighboring villages, sometimes violence occurs over drinking water and residential places because there is not enough water for people and they don’t have shelters and they make homes for themselves in the desert. And they sometimes fight each other over this.
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1980
year
Adult man, rural Afghanistan