The 24th best place to be a mother?

Image courtesy of David Castillo Dominici at
Image courtesy of David Castillo Dominici at

Save the Children’s latest State of the World’s Mothers report has received a lot of media attention. In particular, the news that the United Kingdom comes only 24th in its Mothers’ Index Rankings (in other words, the list of the best and worse places in the world to be a mother) has been greeted with much dismay and finger-pointing.

While there are many admirable things in the report – particularly its focus on the shocking conditions in which women experience pregnancy and birth in many developing countries – the rankings themselves should be taken with a pinch of salt.

The rankings are drawn from five indicators:

  • Maternal health (by which is meant the lifetime risk of maternal death, ie dying during pregnancy or childbirth, or shortly afterwards)
  • Children’s well-being (the under-5 mortality rate)
  • Educational status (expected years of formal schooling)
  • Economic status (gross national income per capita)
  • Political status (participation of women in national government)

Each of these indicators is given an equal weighting.

All are interesting in their own right. But adding them together doesn’t really tell you anything useful about what it’s like to be a mother in each of those countries. Take the political status indicator. The report says that:

“When women have a voice in politics, issues that are important to mothers and their children are more likely to surface on the national agenda and emerge as national priorities.”

This is probably true, but in itself it doesn’t tell us anything about the experience of being a mother. It’s essentially a proxy indicator. If women are well represented politically, then they’re more likely to receive better healthcare, better education and better job opportunities. But there are already indicators for those things, so the political status indicator is just reinforcing the others.

Maternal mortality – a cause for concern?

More problematic is the maternal health indicator: the lifetime risk of maternal death. It’s a useful way of highlighting the difference between a country such as Norway, where the lifetime chance of dying in pregnancy or childbirth is about one in 15,000, and Somalia, where the chance is, shockingly, one in 18. But it’s not necessarily helpful to know that the lifetime chance in the UK is one in 6,900, compared to Greece (one in 12,000) or Iceland (one in 11,500).

That’s because there could be any number of reasons for this variation, such as the size of the ethnic minority population (women from ethnic minorities often have more difficulty in accessing good obstetric care), or the number of pregnancies a woman has in her lifetime, or the age at which she gives birth or her general health. Between 2006 and 2008, 261 women in the UK died of causes directly or indirectly related to pregnancy: half were overweight or obese, and 53 (20%) had problems with substance abuse.

More significantly, some of the variation may just be down to the way data is collected. The country that does best on this indicator is Belarus, where a woman has a lifetime risk of dying in pregnancy or childbirth of one in 45,200: which is more likely – that Belarus provides exceptional healthcare for mothers, or that its method of counting maternal deaths is rather more slapdash?

It’s not an argument for complacency – a figure of one in 6,900 is still too high. But we shouldn’t rush to the conclusion, as some have done, that the UK offers a poorer quality of care for pregnant women and new mothers than other Western countries.