Two Worlds Answer Key

1. (b) 50 years

Baby girls in Ethiopia can expect to live, on average, about 50 years. Life expectancy is even shorter in other poor countries of sub-Saharan Africa where HIV/AIDS is more rampant. In Botswana, for instance, where about a quarter of the adult population is infected with HIV, female life expectancy is only 33 years. Girls now being born in the United States, in contrast, have a life expectancy of about 80 years.

2. (c) Complications of pregnancy or childbirth

While infectious diseases—particularly HIV/AIDS, malaria, and tuberculosis—take a dramatic toll in developing countries, women ages 15-49 are most likely to die from complications of pregnancy or childbirth. Many women in poor nations are particularly vulnerable during pregnancy and labor because they already suffer from malnutrition, anemia, and various infectious diseases. The direct cause of most maternal deaths is uncontrolled bleeding. The second most frequent direct cause is sepsis, a condition triggered by bacteria and other microorganisms and their toxins.

3. (a) 1 in 22

Women in sub-Saharan Africa face grim odds: a 1-in-22 chance of dying from complications of pregnancy or childbirth. When all developing nations are assessed together, the odds are 1 in 75. According to newly released estimates on maternal mortality in 2005, 536,000 women in the developing world die of maternal causes each year—a death every minute. And for every woman who dies, another 35 to 40 suffer debilitating injuries.

4. (c) nearly three-quarters

If all women were adequately nourished from a young age, and they also received appropriate medical care through pregnancy, childbirth, and the post-delivery period, it would dramatically impact the survival of infants. The World Health Organization estimates that such measures could prevent nearly three-quarters of neonatal deaths (deaths within the first 28 days of life). Currently, about four million infants die within their first month. So roughly three million infants would be saved. Better nutrition and medical care for women would also radically reduce stillbirths, which now number 3.3 million worldwide.

5. (b) 28 percent

Twenty-eight percent of women in sub-Saharan Africa give birth by age 18. Many of these women were married off as children and lack the education, money, and status to get adequate nutrition and health care. Some adolescents are still not fully grown when they become pregnant, and other women suffer from stunted growth. Because these women have small pelvises, they face substantial risk of having obstructed labor, stillborn babies, and birth injuries.

6. (b) 56 percent

Across all developing nations, 56 percent of married women ages 15-49 use modern contraception. Contraceptive use has increased greatly in recent years, particularly in Asia and South America. In Brazil, for example, 70 percent of married women use modern methods—more than the 68 percent in the United States. Yet most women in sub-Saharan Africa still lack reliable family-planning methods. Only 18 percent of married women in this region use modern contraception. Worldwide, roughly 135,000 maternal lives could be saved each year if women who did not want children used effective contraception.

7. (b) 5.4

In Ethiopia the average number of births per woman is 5.4, but the picture changes if you focus exclusively on the richest or poorest fifth of the population. The wealthier women have, on average, 3.2 children; the poorest women give birth to 6.6, although these infants are less likely to survive to adulthood than children in wealthier families.

8. (b) 6 percent

Only 1 in 17 births in Ethiopia is attended by a trained professional. For the poorest fifth of the population, such assistance is even rarer; fewer than 1 in 100 births involves a doctor, nurse, or midwife. These births often take place in rural areas that lack clean water and sanitation. If labor is obstructed or another complication arises, as happens in about 15 percent of all births, little can be done to help the baby or mother. Even a healthy woman can die of postpartum bleeding within two hours.

9. (a) none

There were no cases. Fistulas are a consequence of prolonged, obstructed labor, and with good obstetric care, they are entirely preventable. When cesarean section became widely available at the end of the 19th century, fistula injuries were all but eliminated in rich countries. The last U.S. hospital dedicated to treating fistula patients closed its doors in 1895. In contrast, the World Health Organization estimates that there are more than two million women living with untreated fistulas in the developing world.

10. (a) $450

It costs the hospital $450 to not only provide a fistula repair operation and nurse a woman back to health but also give her a new dress and bus fare home, where she can begin her life anew. However, in a country where most people have little or no savings, many poor women lack even the means to get themselves to the hospital. In fact, most fistula sufferers, who live in obscurity in the countryside, are not even aware of the hospital's existence.

11. (c) educating girls and young women

Experts at the World Health Organization, Population Reference Bureau, and elsewhere point to education as a key way to address the abysmal state of maternal health in many developing countries. Education can ameliorate the root causes—poverty, the low status of females, and lack of understanding and access to reproductive healthcare. And educating girls and young women does more than improve the lives of mothers; it enhances the well-being of children, entire families, and broader communities.

A Walk to Beautiful

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• Second Chances
• Two Worlds
• Anatomy of Childbirth
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