For mothers, worst place in world is breast place

Worst & best countries for mothers, flipped on head if assessed by breastfeeding rates

By Elizabeth Willmott Harrop

14 May 2010

Mother and ChildSave the Children’s (STC) State of the World’s Mothers Report 2010, published 4 May, includes a Mothers’ Index which ranks 160 countries as “the best and worst places to be a mother”.

The ranking is based on economic and political factors and health and education, looking specifically at maternal and child mortality. And the main report goes on to make some valid recommendations around the need for more health care workers and the funding of health care systems for marginalised mothers and children.

However, by using these criteria, and the tabloid style “top 10” format, it appears to say that more developed countries equals good for mothering, and less developed countries equals bad.

In terms of mortality rates, this is indeed the case. One in 23 mothers will die from pregnancy-related causes and 9 out of 10 women are likely to suffer the loss of a child in their lifetime, the vast majority in the developing world. And according to research published in the Lancet this month, there were almost 9 million deaths in under 5s worldwide in 2008. 15% of those deaths were from diarrhoea – something so easily preventable with the right diet and sanitation.

Interestingly, the USA has a low ranking among the more developed countries due to its maternal mortality rate which is “one of the highest in the developed world”.

However, while the ranking is valid as an expression of the criteria in the STC report, it nonetheless raises important questions about the imposition of Western values on mothering: i.e. conditions for mothering which the West does not value are not included. Let’s look at the example of breastfeeding to illustrate the point.

We know that breastfeeding has a multitude of benefits to mother and baby including the prevention of infant deaths. The World Health Organization therefore advises that “exclusive breastfeeding for 6 months is the optimal way of feeding infants … with continued breastfeeding up to 2 years of age or beyond”.

Different countries measure breastfeeding rates in different ways and for different years, but the following examples gives an idea of differences in breastfeeding rates between the “more developed” (less developed?) and “less developed” (more developed?) countries.

Exclusive breastfeeding rates:
(countries listed in order of their ranking according to the STC report)

Australia (ranked 2nd) 2007: 14% at 6 months
New Zealand (6th) 2008: 40% at 4 months, 16% at 8 months
UK (14th) 2005: less than 1% at 6 months
Canada (20th) 2008: 14.4% at 6 months
USA (28th) 2006: 13.6% at 6 months.
Peru (60th) 2008 69% at 6 months
Sri Lanka (83rd) 2008 76% at 6 months
Rwanda (122nd) 2008 88% at 6 months
Solomon Islands (127th) 2008 74% at 6 months
Madagascar (134th) 2008 67% at 6 months

For breastfeeding at aged 20-23 months, Sri Lanka (ranked 83rd), Burkina Faso (147th), Ethiopia (145th), Bangladesh (135th) and Nepal (130th) all had breastfeeding rates of over 80%, with Nepal at 95%.

So if you assess the countries according to how well they are living up to the WHO breastfeeding target, you can almost flip the ranking on its head. This is how the list above would look.

Exclusive breastfeeding rates:
(countries listed in order of breastfeeding rates):

Rwanda (ranked 122nd) 2008 88% at 6 months
Sri Lanka (83rd) 2008 76% at 6 months
Solomon Islands (127th) 2008 74% at 6 months
Peru (60th) 2008 69% at 6 months
Madagascar (134th) 2008 67% at 6 months
New Zealand (6th) 2008: 40% at 4 months, 16% at 8 months
Canada (20th) 2008: 14.4% at 6 months
Australia (2nd) 2007: 14% at 6 months
USA (28th) 2006: 13.6% at 6 months.
UK (14th) 2005: less than 1% at 6 months

The same would likely be true if the countries were assessed by social structures which support mothers and families, such as extended families and communal living.

Food for thought.

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Links

Authentic Parenting: The Best – And Worst – Places To Be A Mother
Save the Children Mothers’ Index 2010
Save the Children State of the World’s Mothers Report 2010

Liberty & Humanity

Maternal and Infant Health Articles: