Every mother counts: Or, don’t they?

"She was afraid of dying in childbirth, of leaving her children motherless." - From Half of a Yellow Sun, by Chimimanda Ngozi Adichie.1 In Half of a Yellow Sun, novelist Chimimanda Ngozi Adichie tells the story of Olanna, a professor whose lived experience as a woman collides with conflict during the Nigerian Civil War (1967-1970). In this story, the war over Biafra badly disrupted medical services and civil society, critically endangering the lives of women and their children. Olanna is a fictional character, but her story is not. In fact, it remains the case that too many women across Africa live their lives exposed to the triple-jeopardy of poverty, poor health services, and war. Shortly after the Biafran war, two estimates were published reporting on Nigeria's maternal mortality ratio (MMR, which is technically a rate, not a ratio). Between 1970 and 1976, the MMR was estimated at somewhere between 40 and 1,970 deaths for every 100,000 births. These rough estimates were based on data from two hospitals, one in Lagos and one in Zaira, and about 33,000 total births.2,3 At one end of the spectrum, the highest rate (1,970) was similar to that in England between the 16th and 18th centuries and the lowest rate (40) reflected the MMR for England and Wales in 1940.2 (The author [ABW] calculated the rate of 1,970 as the mean of three rates for women with planned hospitalizations (40 per 100,000), those with planned hospitalizations and complications (370 per 100,000) and those with "unbooked emergencies" [2,900 per 100,000]).