International outreach

One dead every minute. The stark reality is that somewhere between 382,910 and 437,860 women worldwide died from a direct or indirect childbirth-related cause in 1990. This is an astonishing figure that eclipses the number of deaths from natural disasters such as the 2004 Asian tsunami and the 2010 Haitian earthquake. It is made worse when we realize that many of these deaths are avoidable and that there is an enormous variation in mortality rates across the planet. In 2010, Save the Children quoted the lifetime risk in Afghanistan as 1 in 6, compared to 1 in 47,600 in Ireland. Such discrepancies between the developed and developing countries are alarming and have been cited as ‘the largest discrepancy of all public-health statistics’, substantially greater than that for child or neonatal mortality. This chapter considers the size of the problem, the global initiatives aiming to tackle it, Millennium Development Goal 5, the role that obstetric anaesthesia can play, and how those who practise in the developed world can help their neighbours in developing countries.