"Labour" -- the act of giving birth -- is the most dangerous labour in the world. Outside of a small number of
privileged and/or conscientious countries that have succeeded in reducing maternal mortality to close to zero, each
pregnancy and birth is a risky and potentially fatal experience for hundreds of millions of women worldwide.
Some 600,000 die in agony every year.
Gendercide Watch believes that certain institutions can be defined as "gendercidal" in their selectively destructive
impact on women or men. Of the three case-study institutions examined for women -- including female infanticide
and witch-hunts -- maternal mortality is perhaps the least appreciated, and the most devastating.
In a 1996 report, the United Nations Children's Fund (UNICEF) was blunt: "It is no exaggeration to say that the
issue of maternal mortality and morbidity, fast in its conspiracy of silence, is in scale and severity the most
neglected tragedy of our times." According to UNICEF, a staggering 585,000 women die annually from
complications arising from pregnancy and childbirth. And "these are not deaths like other deaths," the
They die, these hundreds of thousands of women whose lives come to an end in their teens and twenties and
thirties, in ways that set them apart from the normal run of human experience. Over 200,000 die of
haemorrhaging, violently pumping blood onto the floor of bus or bullock cart or blood-soaked stretcher as
their families and friends search in vain for help. About 75,000 more die from attempting to abort their
pregnancy themselves. Some will take drugs or submit to violent massage. Alone or assisted, many choose
to insert a sharp object -- a straightened coat-hanger, a knitting-needle, or a sharpened stick -- through the
vagina into the uterus. Some 50,000 women and girls attempt such procedures every day. Most survive,
though often with crippling discomfort, pelvic inflammatory disease, and a continuing foul discharge. And
some do not survive: with punctured uterus and infected wound, they die in pain and alone, bleeding and
frightened and ashamed.
Perhaps 75,000 more die with brain and kidney damage in the convulsions of eclampsia, a dangerous condition
that can arise in late pregnancy and has been described by a survivor as "the worst feeling in the world that can
possibly be imagined." Another 100,000 die of sepsis, the bloodstream poisoned by a rising infection from an
unhealed uterus or from retained pieces of placenta, bringing fever and hallucinations and appalling pain. Smaller
but still significant numbers die of an anaemia so severe that the muscles of the heart fail. And as many as 40,000
a year die of obstructed labour -- days of futile contractions repeatedly grinding down the skull of an already
asphyxiated baby onto the soft tissues of a pelvis that is just too small. In the 1990s so far, three million young
women have died in one or more of these ways. And they continue to die at the rate of 1,600 every day, yesterday
and today and tomorrow. For the most part, these are the deaths not of the ill or of the very old or of the very
young, but of healthy women in the prime of their lives upon whom both young and old may depend. (Peter
Adamson, article from the UNICEF Progress Report in New Internationalist, January/February 1997.)
Moreover, Adamson writes, "The numbers of the dead alone do not reveal the full scale of this tragedy. For every
woman who dies, approximately 30 more incur injuries, infections, and disabilities which are usually untreated and
unspoken of, and which are often humiliating and painful, debilitating and lifelong ... At least 12 million women a
year sustain the kind of damage in pregnancy and childbirth that will have a profound effect on their lives. And
even allowing for the fact that some women will suffer such injuries more than once during their child-bearing
years, the cumulative total of those affected can be conservatively estimated at some 300 million, or more than a
quarter of the adult women now alive in the developing wold."
The worst offenders are in sub-Saharan Africa, where women die in childbirth at rates 160 times those of Canada --
approximately one fatality in every one hundred pregnancies. The overall chance of dying during pregnancy in
Canada is 1 in 7,700; in Africa as a whole, 1 in 21. The ten countries with the highest annual rates of death in
childbirth are: Sierra Leone, Afghanistan, Bhutan, Guinea, Somalia, Angola, Chad, Mozambique, Nepal, and
Who is responsible?
For the most part, Gendercide Watch is skeptical of including individual-level killings, let alone "agentless" ones,
under the rubric of "gendercide." It is important to understand, however, that negligence and conscious oversight
can themselves be means of inflicting murder on a genocidal scale. Human Rights Watch has noted in the case of
communal violence that "a pattern of [government] discrimination" may be evident if conduct "is intended to or
can be reasonably expected to lead to intercommunal conflict." The discrimination may include:
• failure to provide physical protection for vulnerable communities under attack from private actors;
• failure to prosecute those responsible for attacks on targeted communities, whether these are state agents
or private actors;
• persistent official representation of members of a targeted community, in media and official comments, as
less than full citizens or as deserving of less than full respect;
• suppression of dissent by those (of whatever origin) who oppose attacks on or discrimination against the
• and discriminatory legislation, which denies full status and recourse to members of the targeted community
with regard to their rights as citizens of the nation. (Human Rights Watch, Slaughter Among Neighbors: The
Political Origins of Communal Violence [Yale University Press, 1995], p. 10.)
Such a framework can be "gendered" to encompass the institutional discrimination, leading to physical
victimization, that occurs on a massive scale with maternal mortality in the underdeveloped world. Fundamental is
the failure of most states to provide physical protections, in the form of access to a safe and hygienic natal
environment. The suppression and marginalization of women in most respects, and in most countries of the world,
is brought about in precisely the way Human Rights Watch describes. The tools at the disposal of the government
and ruling elites include control over the mechanisms and policies of the state administration (and thus the
possibility to implement or not implement safe conditions for women and their children). They also include control
over the "commanding heights" of the culture -- the ability to selectively choose the subjects and viewpoints that
will be presented for discussion, and the allowable range of debate. Such strategies have long been used to keep
women as "second-class citizens" over most of the world.
To make every pregnancy a spin of fortune's wheel is to consign women during their prime reproductive years to
profound insecurity, and to the ever-present threat of excruciating death or debilitating injury. As one midwife
stated: "If hundreds of thousands of men were suffering and dying every year, alone and in fear and in agony, or if
millions upon millions of men were being injured and disabled and humiliated, sustaining massive and untreated
injuries and wounds to their genitalia, leaving them in constant pain, infertile and incontinent, and in dread of
having sex, then we would all have heard about this issue long ago, and something would have been done."
Those primarily responsible, therefore, are the governments and ruling elites who can always find money for
weapons, but only rarely for hospitals and clinics and midwives; who systematically deny other resources
(educational, legal, contraceptive) to women; and who thereby deny them rights that every human being should
have to control their bodies and their destinies. The failure of the developed world to contribute meaningfully to
the development of the poorer countries is obviously an important factor. But the Cuban example (see below)
demonstrates that even poor countries, by humanely allocating the limited resources they control, can reduce
maternal mortality to levels approximating those of the wealthiest countries in the world. "Even in the largest and
poorest nations," notes UNICEF,
there are usually health units and district hospitals with the doctors, midwives, nurses, drugs, and equipment
that can provide obstetric care when needed. If they cannot, then this usually reflects a lack of priority, or a
lack of relatively small amounts of funds for basic training and equipment, rather than the inherent
impossibility of the task. ... Action on this issue has been paralysed for too long by the idea that only the
building of hundreds more hospitals and the training of thousands more expensive obstetricians can make the
right kind of care available to [those] who need it. But the fact is that properly trained health workers and
midwives, working in modern health units with inexpensive equipment and reliable supplies of relatively
cheap drugs, can usually cope -- and know when to call in obstetricians if a caesarean section is necessary. ...
Reducing maternal deaths and injuries is therefore not a matter of possibilities but of priorities. The
strategies that work have been identified. And the resources will follow if priority lights the way.
On an individual level, those who accept and help to entrench the patriarchal frameworks that deny women
adequate nutrition, education, and health care must shoulder a large portion of the blame for perpetuating this
gendercide against women. Jenifer Joseph gives a good sense of how patriarchal cultural values translate directly
into maternal death:
Pregnant women in Benin would rather suffer days of obstructed labor than ask for help during childbirth
and risk being seen as weak. In parts of Ghana, troubled labor is seen as a sign of infidelity, so women stall
in calling for emergency care while they try to appease the gods to help with their delivery. In southern
Papua New Guinea, women are expected to give birth by themselves, a tradition stemming from a belief that
female blood is contaminated and could sicken or even kill a birth attendant.
"Why is it that a woman dies every minute?" asks World Bank President James Wolfensohn. "The answer is that
people don't care. We assume that women are there. We have never taken enough concern about the rights of
Resistance sometimes comes from unexpected quarters. Adamson writes: "It might have been expected that the
voice of the women's movement would have been raised on behalf of the millions of women who suffer for
reasons that are related solely to the fact of being a woman. But with honourable exceptions, this is an issue on
which the women's movement in the industrialized nations has raised scarcely more than a murmur. When asked,
many of the women who work with maternal death and injuries in the developing world will offer the same
explanation: for most Western women, feminism is in large part a fight against the circumscribing of a woman's
opportunities by her reproductive role; many who are engaged in that struggle have therefore been reluctant to
take on an issue which seems to centre on women as mothers rather than women as women."
Doing it differently: Cuba
Maternity ward in Cuba.
Cuba is a "Third World" country, with limited economic resources. But as a result of policy priorities evident
from the early days of the 1959 revolution, maternal mortality, along with a wide range of other health crises, have
been reduced to "First World" levels. The difference has been a revolutionary regime willing to place the priorities
of rural citizens on an equal footing with urban ones, and to grant all Cubans, urban or rural, similar standards of
health care. Susan Eckstein writes that "Cuba's experience under Castro highlights possible social if not economic
benefits of socialism. Its demographic profile has come to resemble that of highly industrial countries more than
Third World nations. Policies that address islanders' needs from cradle to grave, and that have opened
employment opportunities for women, contributed to a 'demographic revolution.'" The structure emphasizes
grassroots delivery of health services:
The administration of health was centralized and made more uniform while the delivery of services was
decentralized. A well-organized system of health centers, known as polyclinics, was initiated to provide
ambulatory care throughout the country. The polyclinic-based system delivered a fairly standard set of
services and aimed at universal coverage within territorially defined districts. Doctors and support staff
were given responsibility for a given group of families within their assigned district. ... In the context of
Latin America, Castro's Cuba alone offered a universal, institutionalized system of free rural and urban
health care. ... In the capitalist countries in the region, public and private medical facilities remain more
doctor-oriented, more concentrated in the major cities, and less accessible to the masses, and government-subsidized health care is available, in the main, only to the fraction of the labor force who work for the state
or formal-sector private firms. Also, the diversity of Cuba's health care offerings were exceptional by
regional and Third World standards: the high-tech along with low-tech curative and preventive care.
(Eckstein, Back from the Future: Cuba Under Castro, pp. 130-32.)
As a result, "average life expectancy rose from fifty-nine years before the revolution to seventy-six years in 1992.
Cuban life expectancy came to be exceptional even by industrial Western and former Eastern European-bloc
standards. In fact, in the early 1990s men tended to die younger in the United States than in Cuba." Meanwhile,
infant mortality plunged from 36 per 1,000 live births before the revolution to 8 in 1996, and "with nearly 100
percent of all babies born in hospitals, staff were on hand to attend to any birth-related problems." (Eckstein,
Back from the Future, pp. 136-37.) For its part, maternal mortality stood in 1996 at 2.4 per 10,000 births -- barely
above North American rates. The Cuban system has come under enormous strain, as with all other aspects of
Cuban society and infrastructure, in the decade following the collapse of the country's former patron, the Soviet
Union. But these health gains have largely been preserved, and even improved.
Globalizing Cuba's grassroots approach would mean training some 850,000 health workers, according to UNICEF
and World Health Organization reports, as well as the necessary drugs and equipment. The total cost would be
US \\$200 million, about the price of half a dozen jet fighters.
[ Further reading ] [ Back to main ] [ Back to top ]
The most wide-ranging
book ever published on
killing, or "gendercide,"
this collection of
essays is also the first
to explore systematically
the targeting of non-
males in various wartime
and peacetime contexts.
and a full
table of contents.
and the West
well selected, brilliantly
edited collection provides
the most comprehensive
treatment of Western
responsibility for mass
atrocity yet published.
The cumulative impact of
the volume is a devastating
indictment of state terrorism
as practised by the West,
both historically, and now
after September 11 in the
name of 'anti-terrorism.'"
- Richard Falk, Professor
and a full
table of contents.