The BMJ Today: Global differences in pregnancies

wim_weberGlobal inequalities in health and healthcare never cease to amaze me. This week we published a large study from Sweden showing the negative effects of obesity in pregnancy, and we find a report telling us that for €20 ($25, £16) per year per woman we can reduce almost three quarters of unintended pregnancies and unsafe abortions in developing countries.

The Swedish study looked at more than 1.8 million live births in the period 1992-2010, and found that overweight and obesity grade 1 (BMIs 25-34) in pregnancy were associated with modestly increased risks of infant mortality, and obesity grade 2 (BMI 35.0–39.9) and grade 3 were associated with more than doubled risks. In infants born at term, deaths owing to birth asphyxia, other morbidities, and congenital anomalies seemed to explain the increased mortality risk. The authors also report an increased risk of preterm birth among overweight and obese women, which further explains the higher infant mortality in these women.

These data are quite striking, especially when one takes into account that Sweden is not one of the most “obese” western countries (see here for a list of the “top” ten), but even in this study, 24% of women were overweight and 9% were obese in early pregnancy.

Sweden has also been ranked the best place in the world to give birth, and has a very low infant mortality rate (two per 1000 live births). It thus seems likely that obesity’s effects in pregnancy must be worse in other countries.

Compare these data with the recent study reported by Zosia Kmietowicz. Some 225 million women in developing countries want to avoid pregnancy, but do not have access to modern contraceptives, while tens of millions still do not receive basic pregnancy and delivery care.

The authors of the report calculated that providing women in the developing world with essential sexual and reproductive health services costing €20 a year per woman would reduce unintended pregnancies by 70% and unsafe abortion by 74%. They also estimated that if contraceptive needs were met, and all pregnant women and their newborns received the basic standards of care recommended by the World Health Organization, the number of women dying from pregnancy related causes would drop by two thirds: from 290 000 to 96 000.

Twenty euros, that is about five happy meals.

Wim Weber is European research editor for The BMJ