In many parts of the world, women learn to accept the risk of illness, injury, and death as the price they must pay for giving birth; indeed, half a million women and girls prove this through their deaths every year. Among the women who survive childbirth each year, many find their health compromised. Tragically, these women suffer needlessly, because most childbirth-related complications are preventable. That such high maternal morbidity persists in the twenty-first century reflects the enormous gaps that remain between the developed and developing world, particularly in the quality and availability of maternal health care. A particularly poignant example of the disparities in care is the problem of
obstetric fistula (see box on Obstetric Fistula and Its Medical Consequences). Obstetric fistula has all but disappeared in wealthier parts of the world, yet every year, the World Health Organization has estimated that at least 50,000
to 100,000 women and girls—virtually all living in poor communities—develop fistula. The condition appears to be particularly common in Africa.