State of the World’s Mothers Index ranks Bosnia and Herzegovina 48th - Save the Children

Maternal deaths and child mortality in the most challenging countries of the world can be dramatically cut when efforts are made to improve services for mothers and children, Save the Children can reveal in new research published today.

Concerted efforts by Afghanistan and Ethiopia have reduced maternal deaths by almost two thirds since 2000, according to the aid agency’s State of the World’s Mothers Index.

Afghanistan has grappled with armed conflict for decades. Just three years ago, it ranked at the bottom of the annual Index, but by training midwives, improving immunisation coverage and raising girls’ education levels, it has markedly improved women’s and children’s health.

Ethiopia leads the way in mainland Africa. Since 2000, it has reduced maternal deaths more than any other country on the continent.

The Mothers Index – which scores countries on mothers' and children's health, educational, economic and political status – also shows that some Western countries are falling behind other wealthy countries. In the US, the risk that a 15-year-old girl will die during her lifetime from a pregnancy-related cause has increased by over 50 per cent since 2000, from one in 3,700 to one in 2,400. American women face the same risk of maternal death as those in Iran or Romania.

Of the 178 countries surveyed this year, Finland is the best place to be a mother while Somalia is at the bottom.

Bosnia and Herzegovina is ranked 48th, the lowest position among the countries of the former Yugoslavia, with Albania as the only country from the region occupying a lower rank, 83rd out of 178 countries included in the survey.

However, comparisons are most striking when looking at specific indicators. In her lifetime, one Chadian woman in 15 is likely to die because of a pregnancy, compared to one Swedish woman in 14,100. And a child in Sierra Leone has one chance in five of not reaching his or her fifth birthday, whereas for an Icelandic child, this risk is one in 435.

Afghanistan’s progress distinguishes it from many other conflict affected or fragile states, which consistently rank at the bottom.

“The link between conflict affected and fragile states and high rates of maternal and child mortality might seem obvious, but while the numbers of mothers and children dying of preventable causes in these places remain unacceptably high, several countries show that we can save mothers’ and children’s lives despite the effects of a humanitarian crisis", said Chief Executive of Save the Children, Jasmine Whitbread.

"More than half of all maternal and child deaths occur in fragile states or countries affected by conflict like the Democratic Republic of Congo (DRC) or Afghanistan. The vast majority of mothers’ and children’s deaths occur because of crumbling infrastructure, lack of access to essential equipment or because of the lack of a skilled health worker during childbirth."

This year the annual State of the World's Mothers report focuses on mothers in humanitarian crises – from typhoon Haiyan in the Philippines and hurricane Sandy in the US, to mothers living in fragile or war-torn states like the DRC and Syria – in order to better understand and respond to their needs.

"Worldwide, women and children are often much more likely than men to die in a disaster, whether man-made or natural", says Ms Whitbread. "And each year, thousands more mothers and children die in conflict-settings than fighters do in battle. We urgently need to increase access to healthcare in places where state capacity is weak and conflict and insecurity is widespread.  All children have the right to survive, no matter where they are born. Many of these deaths are avoidable, and we can help to prevent them with the right plans and investments before, during, and after a crisis has hit or fighting has intensified.”

Countries with fragile institutions and conflict, often combined with natural disasters, are those where mothers fare the worst. Seven different countries, including the DRC, Niger, Mali, and Guinea-Bissau –all still in the bottom ten – have placed last on the index since it was launched in 2000. Six of these have a history of conflict and all, except Guinea-Bissau, suffered recurring natural disasters over the same period.

In the DRC, it is statistically more dangerous to be a woman or a child than it is to be an armed fighter. Armed violence has torn apart the lives of millions of mothers and children in countries like Syria and the Central African Republic, many of whom are displaced inside their country's borders or surviving precariously in neighbouring countries. Evidence of violence against girls and women in Syria is also mounting, with young refugee girls at increasing risk of early and forced marriages in neighbouring countries.

Investing in girls and women will help ensure mothers have the vital support they need to care for their children after violence has broken out.

While large natural disasters like Typhoon Haiyan and Hurricane Sandy illustrate the importance of helping mothers when vital services are destroyed or disrupted, they also show that after the initial emergency has passed, existing institutions can be rebuilt and aid can get through quickly. Preparedness and disaster risk reduction are critical.

Save the Children is calling upon States, donors and civil society to:

• Build stronger institutions and promote early action, social protection, disaster risk reduction and strong health systems that provide universal health coverage and provide for the most vulnerable;
• Ensure access and the right to quality healthcare;
• Invest much more in women and girls and ensure their protection;
• Design emergency interventions with a longer-term view and the specific needs of mothers and newborns in mind;
• Ensure adequate financing, coordination, and research to guarantee the above can be accomplished.