THE most dangerous day of a child’s life is the day it enters the world—irrespective of where it is born. More than a million children a year die on the first day of life, 15% of all under-five deaths, according to a report by Save the Children, a charity. But by far the riskiest place to be born is sub-Saharan Africa. The region accounts for 12% of the world’s population, but 38% of first-day deaths.
A big reason for this is that many African babies are born too early—in Malawi nearly a fifth of babies are born prematurely, the highest rate in the world. Many more are born too light. In Mauritania and Niger around a third of babies are born underweight.
Poor maternal health and serious undernutrition are big reasons for this. The prevalence of underweight mothers in Ethiopia, Madagascar and Eritrea is particularly high.
To make matters worse, African women often marry and have children at a young age, when their bodies may be too underdeveloped for child birth. About half of all young women in Chad and Niger were mothers by the age of 18.
The report highlights the correlation between low use of contraception, high fertility and poor newborn outcomes. Across sub-Saharan Africa the proportion of women who use modern contraception is less than 16%. In Somalia and Chad it is only 1% and 2% respectively. Women, on average, have five children each.
Health care is woefully inadequate, largely because of a severe shortage of health workers. The region has 11 doctors, nurses and midwives per 10,000 people—less than half the 23 considered necessary to deliver essential care. In Guinea, Niger, Sierra Leone and Somalia, there are fewer than two health workers for every 10,000 people. In Ethiopia up to 90% of women give birth at home with no skilled care. And even in Nigeria, which could soon overtake South Africa as the region’s biggest economy, nearly one woman in five has nobody—not even a family member or friend—to help during childbirth.
The report’s Complete Mothers’ Index ranks 176 countries on five indicators: risk of dying during pregnancy or childbirth, under-5 mortality rate, education, income and female political representation. The ten worst-performing countries are all in sub-Saharan Africa; Congo comes bottom.