Death in perspective.

THE ANNUAL DEATH RATE from maternal mortality is three times greater than from the December 2004 Asian tsunami.

In the year since the tsunami struck the world has seen a tremendous outpouring of aid and money to the survivors in South Asia as well as victims of Hurricane Katrina in New Orleans, Louisiana, and victims of the recent earthquake in Kashmir.

While such disasters and resulting loss of life are extremely tragic, and the compassionate response is commendable, let's not forget that millions of people die every single year (over 57 million in 2002 alone) from causes that are often completely preventable--including respiratory infections, tuberculosis, malaria and other tropical diseases, childhood diseases, and perinatal conditions. In 2002 over half a million women died from pregnancy and childbirth complications. And of the 11 million child deaths in the world each year, almost half are related to severe or moderate malnutrition. Virtually all of these deaths occur in poor, developing countries.

These staggering numbers are met with almost total media silence, at least in Western countries. Why? Could it be because the circumstances of these everyday, "ordinary" deaths just aren't as spectacular and "exciting" as natural disasters like tsunamis? Could it be because people in richer countries--especially those in power--don't care as much about what happens to poor, non-white people on the other side of the world?

What if the world invested just half as much of the money and resources each year into preventing these deaths as it usually spends to help disaster survivors? Countless lives could be saved on an ongoing basis. Perhaps some of the diseases could even be eradicated. But because disasters are sudden, dramatic, and newsworthy, "ordinary" deaths that happen daily are easily marginalized or ignored.

The annual death toll from pregnancy complications is particularly tragic. According to the World Health Organization (WHO), out of 510,000 maternal deaths, less than 2,500 occur in developed countries. While one woman in 2,800 can expect to die from a pregnancy in the developed world, one in sixteen will die in poorer regions. This represents the largest disparity between developed and developing regions regarding any health statistic. Also, for every pregnant woman who dies, about thirty suffer serious injury, infection, or disability--that's over 15 million women a year. Babies often don't survive either--three million infant deaths and stillbirths occur every year as a result of pregnancy complications and maternal death. And, as the Panos Institute reported in 2001, when a pregnant woman dies, her existing children have a much higher risk of dying within the next two years.

Why do maternal deaths occur and what can be done to prevent them? According to WHO, the most common direct causes of these deaths are severe bleeding (25 percent), infection (15 percent), ravages of an unsafe abortion (13 percent), eclampsia (12 percent), and obstructed labor (8 percent). In addition, 8 percent of the deaths occur due to ectopic pregnancies, embolisms, and anesthesia-related incidents. Another 19 percent of maternal deaths are indirectly caused by such preexisting disorders as malaria, anemia, and heart disease.

In its 2004 report, Beyond the Numbers: Reviewing Maternal Deaths and Complications to Make Pregnancy Safer, WHO states: "Maternal mortality offers a litmus test of the status of women, their access to health care, and the adequacy of the health care system in responding to their needs." The most common situation that pregnant women in developing countries face is no access to healthcare or poor quality healthcare, both of which are caused or made worse by poverty and ignorance. All these factors reflect a lack of commitment to women's health and welfare by governments and policymakers.

In Maternal Mortality, a review of studies conducted by WHO from 1998 to 2003, Nasr Adbalia Mohamed lists the following major risk factors in developing countries for maternal deaths:

* poor quality or no maternal health care

* female illiteracy

* teenage pregnancy (often because of forced early marriage)

* high parity (having several children already)

* delays in reaching and receiving healthcare services

* unsafe abortion (usually illegal)

* malaria, HIV, anemia (preexisting illnesses)

* harmful traditional medical beliefs and practices

* inadequate facilities to deal with obstetric emergencies

* deteriorating economies

* gender violence

* pregnancy in women over age forty with high parity

* civil war

Other contributing factors to maternal deaths include malnutrition, little access to contraception, lack of obstetric drugs, and repressive laws and policies. In recent years, some of these risk factors have improved, while others have gotten worse--including deteriorating health services and civil war. For example, George W. Bush's 2001 "global gag rule" (which prohibits healthcare agencies in foreign countries from even mentioning abortion if they want to receive U.S. funds) has led to significant increases in maternal and infant deaths in some developing countries because many women's health clinics have been forced to close down or turn away patients needing help.

Africa is home to a disproportionate number of maternal deaths--just over half of the world's total. In some parts of Africa, one in seven women die from pregnancy. This is where another important risk factor comes into play. Tens of thousands of women's lives could be saved in Africa with the simple allocation of a drug that's already safely used in the rest of the world: misoprostol, a synthetic prostaglandin. This essential drug is used to induce labor, soften the cervix, stop postpartum bleeding, and complete unsafe abortions. Misoprostol literally saves pregnant women's lives when they experience eclampsia and hemorrhage. But misoprostol isn't registered for use in most African countries because of money and politics. The drug isn't profitable to the U.S. pharmaceutical firms that manufacture it. Earlier this year WHO added misoprostol to its list of essential medicines, but only when used together with the abortion pill mifepristone, and only "where permitted under national law and where culturally acceptable." This has zero benefit for most African countries, where abortion is still widely illegal. Governments and policymakers in African countries could insist on misoprostol being made available by itself, but they don't, probably because women's healthcare tends to be overlooked and ignored due to the very low status of women in Africa. This in turn translates to a lack of political will to fix the situation.

Although reduction of maternal mortality is one of the major goals of the World Health Organization, much remains to be done. High rates of maternal deaths have persisted since the International Safe Motherhood Initiative was launched in 1987. The struggle has been hampered by logistical problems in counting and estimating maternal deaths and an initial lack of consensus on effective strategies. It's also proven very difficult to provide healthcare in remote or war-torn areas, obtain resources and funding, educate women in countries where most women are illiterate, and persuade local governments to implement progressive laws and policies. For example, criminal laws against abortion should be repealed because they do nothing to stop abortion. Instead, they force 20 million women to resort to dangerous illegal abortions every year, killing 70,000 of them and maiming millions. Unsafe abortion is also the only cause of maternal mortality that is entirely preventable.

The global community has its priorities skewed. Politics and public relations drive the phenomenal responses to the tsunami and other disasters, while a massive tidal wave of death continues to swamp large parts of the world--largely out of sight and out of mind. Disaster victims certainly deserve our help, but our generosity is wildly out of proportion when we consider the millions of preventable deaths that occur year after year in developing regions. In particular, reducing maternal mortality cannot be achieved in isolation from the broader issue of gender inequality. Put simply, if women were valued, resources would be made available to ensure their wellbeing. Meanwhile, millions of women continue to suffer and die needlessly, along with their children.

Joyce Arthur is a pro-choice activist and freelance writer from Vancouver, British Columbia. She is a co-founder and spokesperson for Canada's national pro-choice group, the Abortion Rights Coalition of Canada, and edits the national newsletter Pro-Choice Press.