From Poverty to Power Green, Oxfam 2008 - weman

4 RISK AND VULNERABILITY HEALTH RISKSone in seven in Niger to one in 47,600 in Ireland. 66 In 2004, WHOestimated that sub-Saharan Africa, between 2001 and 2010, would see2.5 million maternal deaths, 49 million maternal disabilities, and7.5 million related child deaths. Children who have lost their mothersare up to ten times more likely to die prematurely than those whohave not. 67Maternal mortality reflects ethnic as well as economic inequalities.In Mexico, the risk of dying of causes related to pregnancy, childbirth,or postpartum is three times higher in indigenous communities thanin the rest of the country. 68The struggle against ill health, ignorance, and poverty starts in thewomb. A quarter of children in the developing world have a birthweight below the critical minimum of 2.5kg because their mothers areundernourished. 69 Evidence from countries where girls are taken outof school and married off in their early teens shows the link betweenearly motherhood and babies who are more likely to be underweightand have a lower chance of survival. 70 Malnourished children aremore likely to fall ill, less likely to perform well in school, and so lesslikely to earn a decent income in adulthood.The failure to bring down maternal mortality rates contrasts withsolid progress in other areas where state capacity is clearly improving,such as improvements in access to water and sanitation. The rapidscale-up in global immunisation since 2001 has also reduced the deathtoll, saving an estimated half-a-million lives. 71 As a result, in terms oflife expectancy poor countries are catching up with rich ones.The record on providing health services to poor people around theworld is one of some success in targeted interventions, against a backgroundof disintegrating systems and increasing inequality. Mosthealth-care services are provided by national systems that have beenunderfunded for decades. Global efforts to boost health-care coveragehave provided essential support, but founder on this legacy of neglect.For example, immunisation coverage has greatly increased sinceWHO launched its Expanded Programme on Immunisation in 1974.In 2006, global coverage for DTP3 (three doses of the diphtheria–tetanus–pertussis combination vaccine) was 79 per cent – up from20 per cent in 1980. 72 Unfortunately this was done in a way that didnot provide the necessary investment in underlying health services.239