One measurement of the quality of healthcare in a country is how safe it is for a woman to get pregnant. It is never entirely safe. There are always going to be some women who die. In the best served countries the number who die is very small, probably fewer than 10 per 100,000 live births. Most countries in Western Europe achieve this. A paper in today's Lancet has looked at records of 181 countries and examinsed whether they have improved since 1980.
Worst of all is the Central African Republic, followed by Malawi and Chad, all with a maternal death rate of greater than 1%. These are some of the poorest countries in the world. HIV is rife and many of these women would have died even if they had not been pregnant. Almost as bad is Afghanistan, which is getting worse, though this might represent better ascertainment now that deaths are more likely to be reported. We should like to see an improvement in healthcare with all those foreign troops there.
Most disappointing is the position of the United States. Again the deterioration here might be due to a different method of counting, but it looks as though it is more than twice as dangerous to have a baby in America than in Sweden.
The UK is about average for Western Europe; the same as Germany. Interestingly France is slightly worse and Italy slightly better, though these differences are at the limit of statistical significance. Cyprus is the big stand-out where things are 5 times as bad - probably because of the high incidence of thalassemia on the island.
In Eastern Europe, both the Czech Republic and Slovakia are down to the levels of Western Europe and Japan, Australia, New Zealand and Canada are down to similar low levels.
The United States is in the next tier with between 10 and 20 maternal deaths per 100,000 pregnancies, along with Portugal, Yemen, Singapore, South Korea, Taiwan, Albania, Hungary, Poland, Serbia, France and the United Arab Emirates.
Things are getting worse in most of sub-Saharan Africa (the influence of AIDS) but they are getting better in much of Asia, North Africa, Latin America and in the former communist states of Eastern Europe.
These comparisons are often not comparing like with like and some countries deliberately mis-state their statistics for reasons of national pride. Again one year's figures often have fairly large confidence intervals, especially in small countries. Nevertheless, there is a stark contrast between rich and poor countries, though it is noticeable that American influence post 1945 has greatly reduced maternal mortality in countries like Japan, Germany, Taiwan, South Korea, Vietnam and the Philippines. However, pariah states like Burma, the Maldives, North Korea and Iran have all improved remarkably.