Maternal mortality, women's status, and economic dependency in less developed countries: a cross-national analysis
Introduction
According to what we consider the most reliable data source currently available (WHO, 1996), globally approximately 585,000 women died from pregnancy-related causes in 1990. Rates of maternal mortality show a greater disparity between rich and poor nations than do any of the other commonly used public health indicators, including infant mortality rate, the indicator which is most often taken as the primary measure of comparative disadvantage Royston and Armstrong, 1989, WHO, 1996. Women who become pregnant in developing countries face a risk of death due to pregnancy that is 80 to 600 times higher than women in developed countries (United Nations, 1991). In 1990, the average maternal mortality rate in the developed countries was 27 per 100,000 live births, while in countries such as Angola, Bhutan, Chad, Guinea, Nepal, Sierra Leone, and Somalia the rates were at least 1500 per 100,000 live births (WHO, 1996). In most developing countries, between a quarter and a third of the deaths of women in their reproductive years can be attributed to pregnancy-related causes (Royston and Armstrong, 1989). In some rural areas of Africa and South Asia, of every two women who die, one dies from pregnancy related causes.
Very often, the death of a woman in childbirth is described as a tragic misfortune due to the risky process of childbirth and is accepted as unavoidable. But such a description does not give adequate attention to the many factors that influence the level of risks associated with pregnancy and childbirth. Maternal mortality is a particularly sensitive indicator of inequality and social development as well as health. Due to the importance of maternal mortality as an indicator of social development for developing countries, the reduction of maternal mortality has been established as a goal for the health of women and children by both the World Health Organization and the United Nations; it has also been described as one of the major public health goals at several recent international conferences (WHO, 1996).
Among the major direct causes of high maternal mortality in developing countries are: births not attended by trained personnel, lack of availability or access to backup services for high-risk pregnancies, and malnutrition among pregnant women (United Nations, 1991). Much of the literature on maternal mortality focuses on its medical, social, and cultural causes that vary among countries and geographical regions (e.g., Chen et al., 1974, India, 1981, Fortney et al., 1986, Walker, 1986, Hertz et al., 1994). It is of note that in cross-national quantitative studies on maternal mortality in less developed countries (LDCs), two important perspectives have been largely overlooked.
One is the examination of the impact of women's status on maternal mortality. Maternal mortality tends to be attributed to causes such as poverty and underdevelopment typically assumed to put both men and women at the same disadvantage with respect to health status. Even though women's educational status has long been recognized as an important factor affecting fertility, infant mortality, and maternal mortality (Caldwell, 1979, Caldwell, 1993), sex discrimination in general as a contributory factor has not been given much attention (Royston and Armstrong, 1989). With the increased data availability in recent years, some studies have used indicators other than education to study issues related to women's status and autonomy in LDCs Marshall et al., 1988, Osirim, 1992, Boehmer and Williamson, 1996. However, very few cross-national quantitative studies have examined maternal mortality with these measures.
The second is the effects of economic dependency and the globalization of the world economy on maternal mortality in LDCs. Economic dependency theory has been applied in a number of cross-national studies dealing with basic human needs provision such as fertility, infant and child mortality and women's social status (Ward, 1984, Ward, 1985, London and Williams, 1990, Wimberly and Bello, 1992, Shen and Williamson, 1997). But very few cross-national quantitative studies have analyzed the effects of economic dependency on maternal mortality in LDCs.
Our study examines the effects of several key external and internal factors on cross-national variation of maternal mortality in LDCs. We call these factors `causes behind the direct causes'. We are interested in how women's status affects maternal mortality in societies with similar economic development level and in how economic dependency impacts maternal mortality directly and indirectly via other key predictors of maternal mortality.
Section snippets
Theoretical and empirical background
We attempt to explain the cross-national variation of maternal mortality using predictors linked to three different theoretical perspectives: modernization theory, gender stratification theory, and economic dependency theory.
Research design
Although many countries have experienced reductions in maternal mortality rates in recent decades, for many of the poorest nations, particularly those in sub-Saharan Africa, there is little evidence of decline (United Nations, 1995). According to estimates by the United Nations, the situation has not improved in most of sub-Saharan Africa and has worsened in some parts of Africa. For many LDCs there is little if any reliable maternal mortality data for the 1960s and 1970s. Due to these reasons,
Results
Researchers doing cross-national research based on aggregate data are routinely confronted with a number of methodological issues such as data being available for a limited number of countries, data reliability problems, outliers, influential cases, multicollinearity, and unstable results in the presence of additional control variables. We have adopted a number of strategies designed to deal with many of these methodological concerns.
A small number of influential outliers can have a substantial
Discussion and conclusions
As a particularly sensitive indicator of inequality, maternal mortality reflects the status of women, their access to health care, and the adequacy of health care system in responding to women's special needs. Maternal mortality has many causes. This study considers several predictors tapping factors behind the direct causes, especially those reflecting aspects of women's status relevant to maternal health. It also gives considerable attention to several indicators we refer to as external
References (81)
Health transition: The cultural, social and behavioral determinants of health in the Third World
Social Science and Medicine
(1993)- et al.
Social and environmental factors and life expectancy, infant mortality, and maternal mortality rates: Results of a cross-national comparison
Social Science and Medicine
(1994) Maternal mortality in Jamaica
Lancet
(1986)Modernization Theory and Economic Development: Discontent in the Developing World
(1993)- et al.
The impact of women's status on infant mortality rate: A cross-national study
Social Indicators Research
(1996) - et al.
Regression diagnostics: An expository treatment of outliers and influential cases
Sociological Methods and Research
(1985) - et al.
Macrocomparative research methods
Annual Review of Sociology
(1993) - et al.
Transnational Corporations and Underdevelopment
(1985) - et al.
Cross-national evidence of the effects of foreign investment and aid on economic growth and inequality: A survey of findings and a reanalysis
American Journal of Sociology
(1978)
Women's Role in Economic Development
Dependency and rebellion: A cross-national analysis
American Sociological Review
Intensifying global dependency: Foreign debt, structural adjustment, and Third World underdevelopment
Sociological Quarterly
Foreign capital penetration, state intervention, and development in Sub-Saharan Africa
International Studies Quarterly
Borrowing against the future: Children and Third World indebtedness
Social Forces
Modes of extraction, unequal exchange, and the progressive underdevelopment of an extreme periphery: The Brazilian Amazon, 1600–1980
American Journal of Sociology
Education as a factor in mortality decline: An examination of Nigerian data
Population Studies
Cultural and social factors influencing mortality levels in developing countries
Annals of the American Academy of Political and Social Science
Gender equality: Toward a theory of change
Maternal mortality in rural Bangladesh
Studies in Family Planning
Contrasting perspectives on women's access to prestigious occupations: A cross-national investigation
Social Science Quarterly
Dimensions of social inequality in the Third World
Population Research and Policy Review
Economic dependency and fertility in Asia and Latin America, 1960–1980
Comparative Social Research
Dependence, inequality and the growth of the tertiary: A comparative analysis of less developed countries
American Sociological Review
Reproductive mortality in two developing countries
American Journal of Public Health
Dependent Accumulation and Underdevelopment
Fertility decline: Theories
Foreign investment and development: Theories and evidence
Trade dependence and fertility in Hispanic America: 1900–1975
Family Welfare Programme in India: Yearbook 1979–1980
Becoming Modern: Individual Change in Six Developing Countries
Foreign Private Investment in Developing Countries
Modernization and demographic transition: Cross-sectional and longitudinal analysis of a revised model
Sociological Focus
Lessons from the past: Policy implications of historical fertility studies
Population and Development Review
Real GDP for more than one hundred countries
The Economic Journal
The political and economic determinants of health outcomes: A cross-national analysis
International Journal of Health Services
Dependence, distorted development, and fertility trends in noncore nations: A structural analysis of cross-national data
American Sociological Review
Multinational corporation penetration, protest, and basic needs provision in non-core nations: A cross-national analysis
Social Forces
National politics, international dependency, and basic needs provision: A cross-national analysis
Social Forces
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