in childbirth, down from more than 5 percent in 1990 (figure 5c). In Chad and Somalia, both fragile states, lifetime risk is still more than 6 percent, meaning more than 1 woman in 16 will die in childbirth. Reducing maternal mortality requires a comprehensive approach to women’s reproductive health, starting with family planning and access to contraception. In countries with data half of women who are married or in union use some method of birth control. Household surveys of women show that some 200 million women want to delay or cease childbearing, and a substantial proportion say that their last birth was unwanted or mistimed (United Nations 2012). Figure 5d shows the share of women of childbearing age who say they need but are not using contraception. There are large differences within each region. More surveys have been carried out in Sub-Saharan Africa than in any other region, and many show a large unmet need for family planning. Women who give birth at an early age are likely to bear more children and are at greater risk of death or serious complications from pregnancy. The adolescent birth rate is highest in Sub- Saharan Africa and is declining slowly. A rapid decrease in South Asia has been led by Maldives, Afghanistan, and Pakistan (figure 5e). Many health problems among pregnant women are preventable or treatable through visits with trained health workers before childbirth. Skilled attendants at delivery and access to hospital treatments are essential for dealing with lifethreatening emergencies such as severe bleeding and hypertensive disorders. In South Asia and Sub-Saharan Africa fewer than half of births are attended by doctors, nurses, or trained midwives (figure 5f). Having skilled health workers present for deliveries is key to reducing maternal mortality. In many places women have only untrained caregivers or family members to attend them during childbirth.
Economy
States and markets
A wide range of needs
5d
Unmet need for contraception, most recent year available, 2006–10 (% of women married or in union ages 15–49) 50
Regional median
40
30 20
10 0
East Asia & Pacific
(7 countries)
Europe & Central Asia
(10 countries)
Latin America & Caribbean
(9 countries)
Middle East & North Africa
South Asia
(5 countries)
Sub-Saharan Africa (31 countries)
(6 countries)
Source: Demographic and Household Surveys, Multiple Indicator Cluster Surveys, and World Development Indicators database.
Fewer young women giving birth
5e
Adolescent fertility rate (births per 1,000 women ages 15–19) 150 Sub-Saharan Africa South Asia 100 Latin America & Caribbean 50
Middle East & North Africa Europe & Central Asia East Asia & Pacific
0
1997
1999
2001
2003
2005
2007
2009
2011
Source: United Nations Population Division and World Development Indicators database.
Every mother needs care
5f
Births attended by skilled health staff, average of most recent year available for 2007–11 (% of total) 100
75
50
25
0
East Asia & Pacific
Europe Latin Middle East South Sub-Saharan & Central America & & North Asia Africa Asia Caribbeana Africaa a. Data are for 1998–2002. Source: United Nations Children’s Fund and World Development Indicators database.
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World Development Indicators 2013 11