Despite the amazing sophistication of today's world, many people are born, live and die without even being counted. Billions of tweets and e-mails circulate in cyberspace, but meanwhile we can't even count human beings properly? Incredible, but true. "Born, lived and died - but counted or not?" is the title of a new report from the Institute of Development Studies, the Alpha Network, the INDEPTH Network and the Health Metrics Network, exposing the scandal of those global citizens who don't even get counted.
Figures on births, lives and deaths are technically known as "vital statistics" - literally meaning statistics about life. But they are also vital in another sense - planners of health care and other services desperately need to know about the populations they are trying to serve, rather than relying on guesses and assumptions. So counting people - and thus making people count - is not an optional extra, it's an essential part of functional societies. In a few communities people may be counted as part of research programmes - but that needs broadening into much wider routine coverage.
Deaths among pregnant women are a special cause for concern. With good care, they are almost all avoidable. But in many poorer parts of the world, many mothers are still dying unnecessarily, and, to add their insult, not even being counted properly as maternal deaths. Millennium Development Goal 5 set a target to hugely reduce maternal deaths by 2015 - but in the absence of good counting, it may be less than clear whether or not that goal will actually be reached.
What kills women during pregnancy and early motherhood? The causes are not simple - it may be directly due to lack of adequate medical care during pregnancy and around delivery, or it may be other diseases occurring more or less coincidentally during pregnancy. HIV/AIDS is an added source of confusion here - are women living with AIDS more or less likely to die when they are pregnant than at other times? Even that is a question that is not so far well understood - but a current collaboration between the Alpha and INDEPTH Networks hopes to find answers by analysing data from some population research sites in Africa.
If it is difficult to understand the effects of HIV on pregnancy, it is sometimes even more difficult to decide whether a particular person has died as a result of their HIV infection, whatever the illnesses may be that led to their death. Verbal autopsy is a key resource here - and all the time better tools are being developed by the Health Metrics Network, the World Health Organization and others to make it easier to decide reliably on causes of death. Work is in progress on simple technology-based solutions, like the one pictured, to hugely increase the coverage of reliable vital statistics, including cause of death.
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