The World’s Worst Place to Give Birth

Despite a booming economy, a new report says maternal health in India is worse than in sub-Saharan Africa.

An Indian doctor examines an expecting mother in a maternity ward at a public hospital in Nawanshahr. (Photo: Narinder Nanu/Getty Images)

Mar 4, 2015· 3 MIN READ
Esha Chhabra is a journalist who covers social enterprise, technology for social impact, and development.

It's a devastating statistic: Globally, about 800 women die from pregnancy- and childbirth-related complications every day, according to UNICEF—and 20 percent of these women reside in India. That's about 55,000 women a year, in a single country.

The poor state of maternal health in India has long been on the global radar, but a study released this week in the Proceedings of the National Academy of Sciences sheds light on startling findings: Despite living in the world's fastest-growing economy, many Indian moms-to-be and their newborns suffer from worse health than their counterparts in some of the world's poorest countries. Because India today is where one-fifth of the world's babies are born, these findings have "global significance," according to study author Diane Coffey of Princeton University.

Here are three things you need to know from the study:

1. Prepregnant women in India are more likely to be underweight compared with prepregnant women in sub-Saharan Africa—and Indian children grow up to be significantly shorter and smaller than African children.

(Photo: Vivek Prakash/Reuters)

"In India, people are richer, better educated, and have fewer children than those in sub-Saharan Africa, so it's really surprising that Indian children are shorter and smaller than those in sub-Saharan Africa," Coffey told The New York Times. "But when you step back and look at the state of Indian mothers, it's not such a surprise after all."

Forty-two percent of women studied in India are underweight before they become pregnant, compared with 16.5 percent of prepregnant women in sub-Saharan Africa. The report cites social and environmental factors but especially gender dynamics within the culture: Indian women are often last in the family to eat, after their husbands and children have been fed. Treated like the runt in a pride of lions, women often eat less as a result. Poor sanitation throughout the country is also a factor. It leads to waterborne diseases and infections, resulting in weight loss and weak overall health.

According to UNICEF, 28 percent of all children born in the country are underweight, usually weighing in at under 6 pounds at birth. Failure to develop to age-appropriate height, a phenomenon typically caused by malnutrition and known as stunting, is a nationwide issue, and the government has been collaborating with UNICEF and the World Health Organization to fight it. Some major progress has been made; the state of Maharashtra saw the fastest decline in stunting, from 39 percent in 2006 to 24 percent in 2012, owing in part to increased maternal nutrition and education.

2. Women in India and sub-Saharan Africa have one thing in common: They put on around half the weight during pregnancy as recommended by the U.S. government.

Coffey emphasizes two factors in her study as being key to measuring maternal health: prepregnancy body mass and weight gain during pregnancy. In both regions, she found that women gain only about 7 kilograms. In comparison, U.S. national guidelines recommend 12.5 kilograms to 18 kilograms of weight gain for underweight mothers. This is especially troubling for Indian women, who are already significantly more underweight than their African counterparts, according to Coffey, because it can increase their risk for complications during childbirth—leading to that troublingly high death toll.

(Photo: Vivek Prakash/Reuters)

3. India's low birth weights are not limited to lower-class families or women.

Even relatively privileged groups suffer from malnutrition, and 25 percent of men between the ages of 40 and 50 were found to be underweight as well, according to the Demographic and Health Survey conducted by USAID in 2005. Exposure to infectious disease, poor sanitation, and substandard diets also affect Indians across socioeconomic strata, Coffey writes.

The Indian government is not in the dark about its maternal health woes. The country developed a five-year plan starting in 2013 to tackle infant and maternal health, focusing on increasing births under the care of skilled birth attendants, promoting home-based care for newborns, educating new moms on how to best feed their children, and providing universal immunization coverage.

India did see a drop in maternal deaths between 2007 and 2012, from 212 for every 100,000 live births to 178. But one of the country's greatest challenges is that it doesn't have a national monitoring body, like the Centers for Disease Control and Prevention in the U.S. The Indian government is working with UNICEF to scale up maternal health-tracking software that can gather better data, which would determine and analyze the causes of death in childbirth. UNICEF projects that the program will be operating in 10 states this year and will be nationwide in 2016.