Third-World Mothers Face Death to Bring New Life Into the World

Fatuma Issa bore her eighth child in a concrete shelter on the edge of the desert, accompanied only by a teen-age midwife she had never met.

Issa, 36, strong and lucky, survived the delivery, but thousands of other women around the world in circumstances similar to hers die each day in childbirth or from complications related to pregnancy.

The world’s poorest nations account for about 90% of the 500,000 women who die each year in childbirth, from complications during pregnancy or from illegal abortions.

International efforts are under way to save women’s lives, but changes are slow.

In Northern Europe, 9 or 10 women die out of every 100,000 who give birth. In Niger and other parts of West Africa, the toll is 700 of every 100,000, according to United Nations’ studies.

And for every woman who dies, at least 10 are permanently handicapped by a complication during pregnancy or delivery, a U.N. Children’s Fund (UNICEF) study reports.

For each of the 500,000 women who die, at least two children are left orphans, says UNICEF, calling the figures “the statistics of shame.”

UNICEF, the World Health Organization, the World Bank and others have taken steps in the last few years aimed at reducing maternal mortality rate by half in the next 25 years.

The problem was forcefully illustrated in 1987 at a conference on maternal mortality in Nairobi, Kenya, by Dr. Attiya Inayatulla of Pakistan, when he told other delegates: “It is intolerable that thousands of women die alone, in suffering, when they are in the process of giving life, and that we should do so little to help them.”

The day Issa gave birth, a second international meeting was taking place about 50 miles down the road in Niger’s capital, Niamey. The meeting, under the auspices of the World Bank and U.N. groups, was designed to raise awareness of the problem among officials in 22 French-speaking African countries and to encourage them to help women and increase family planning.

Health ministers were hammered with evidence that women hold the key to helping African nations struggle out of poverty.

At the close of the meeting, delegates issued a declaration calling on African nations to do more to save the lives that are being squandered.

Women, the declaration said, are not dying from the natural dangers of childbirth, but from bad health, ignorance, poverty and an inferior social status that is beyond the imagination of most women in the West.

Every morning for most of the last 19 years, Issa has risen before dawn to walk an hour for a bucket of water for cooking and washing. There is no water source in her village of helmet-shaped straw huts. After being fed a meager meal, her children scour for firewood in the vast expanse of dusty scrubland that supports few trees.

Standing before a hip-high trough, she begins pounding millet, the staple of Niger’s diet. In blazing heat and dusty wind, she pounds the grain for eight hours, first in the morning and again in the afternoon. She then walks another hour for more water.

She also plants and maintains a garden, feeds the livestock, cares for her eight children and elderly family members, cleans the hut and does what is demanded by her husband. He grows millet a few months of the year when it rains and spends hours talking with other men in the village.

“How can we ease the burdens that rest on the shoulders of African mothers?” Edward Jaycox, World Bank vice president for Africa, asked at the Niamey conference. “It is a question at the very heart of the development of Africa.”

African women work 12 to 16 hours a day, account for an average of 60% of what many nations produce and furnish 80% of what their families eat.

“The African mother is the foundation of African society,” Jaycox said. “Yet, she is also the most vulnerable member of that society. When food is in short supply, she is the one who goes without. When there is no doctor, she is the one who must deal with the risks associated with frequent pregnancies. . . . And when the national quality of life plummets, she is the first to face the consequences.”

Issa has experienced some of that. Throughout her childhood when food was short in the decades of recurring drought, her nine brothers and her father got first choice. She was lucky to have grown up at all, given the rate of child deaths in poor countries.

The death rate for Third World children in their first year of life is 21% higher for girls than boys. Fourteen percent of girls suffer serious malnutrition, while only 5% of the boys do, a World Health Organization study reports.

Malnourished girls grow into undernourished women. Two-thirds of pregnant women in developing countries suffer from anemia and many more suffer vitamin deficiencies related to poor diet.

Bad health leads to problem pregnancies, but few women have access to medical care. Only 44% of Third World women in labor receive medical care. In many countries, about 80% of all births take place at home. About half the time, these women are alone, national studies report.

Niger, like several African countries, has taken preliminary steps to improve health services for expectant mothers. The aging, concrete shelter where Issa had her baby is one of about 80 maternity centers set up by the government around the nation.

But in a poor country like Niger, where per capita income hovers around $260 a year, medical service is rudimentary at best and the standards of service differ widely.

Even in the capital, where six multipurpose complexes offer prenatal, obstetric and early pediatric care by trained midwives and health workers, the centers often lack sufficient antibiotics, painkillers and plasma.

Rural facilities frequently lack electricity and running water and are often more like the center here--two crude rooms with a few yellowed cots and an inexperienced midwife the expectant mothers have never seen before.

Too Early, Too Late

Despite the lack of health care and many dangers, African women continue to give birth too often, too early and too late.

Issa married in her teens, like 70% of the women in West Africa but only 7% in Europe. She had her first child at 17.

African women often produce their first baby around the age of 15 and continue having children every year or two until menopause. Issa says she has had enough.

“I’m tired, really tired,” she said, sitting on a dirty foam mattress without sheets the day after she gave birth.

“I want to take something to stop having babies. My husband may not want to accept it, but he’s not the one who’s tired,” she added in the tribal language Djerma, speaking through a midwife who translated.

In rural areas, UNICEF reports, 50% of the women who had their first child before 15 were dead by the age of 50 from causes linked to the trauma of frequent pregnancies.

Customs Are an Obstacle

But only about 2% of African women have access to modern birth control or information on family planning. Laws, customs and religious beliefs stand in the way.

Until Niger adopted a new birth control law last April, women needed written permission from their husbands even to visit a family planning center. In some countries, women need permission from their spouses to leave a village.

They cannot vote. They can neither own property nor inherit it. They cannot decide whom to marry or divorce, and they are prohibited from seeking an education.

Female literacy in West Africa hovers around 6%, compared to 20% for African men and 99% for women and men in North America.

‘Has to Go On Pleasing Him’

“Women have no options,” said Perdita Huston, spokeswoman for the London-based International Planned Parenthood. “She may be desperately tired and not want another child, but she doesn’t want to disappoint her husband. She has to go on pleasing him.

“You can talk about safe motherhood until you are blue in the face and accomplish nothing until you convince the men.”

Huston added, however, that attitudes gradually are changing. Recurring drought and famine in African countries bordering the Sahara produced a “psychological shock” to African governments, forcing them to reconsider limiting population growth.

Chiefs of states and heads of families are realizing that they don’t need any more mouths to feed.

World Bank lending for programs related to women’s health and birth control will triple over the next five to eight years.

‘But There Is Hope’

“We need to put our money where our mouth is,” said M.J. Gillette, the World Bank’s director of the Africa Country Department.

“But there is hope. Since the late 1970s . . . there has been a tremendous reversal of spirit in Africa and a real intellectual grasp of the situation,” Gillette said. “Women are organizing and they are going to take care of this problem. Governments are recognizing the link between development and population control, and they are changing policies.

“The last obstacle to family planning is the African man, and he is waking up. There are forces loose in African society that he can’t control anymore.”