The World’s 10 Best and Worst Countries to Be a Mother

The verdict is in: Norway ranks first in the health and well-being of its mothers and children and Somalia ranks last out of 179 countries surveyed, according to Save the Children’s 16th annual State of the World’s Mothers report, published this week in partnership with the Bill and Melinda Gates Foundation (which also funds TakePart World).

Key to the report—which looks at the health, educational, economic, and political status of mothers and children and is subtitled The Urban Disadvantage—is its findings on the status of poor urban communities. Behind the glossy facade of modern city life, nearly 1 billion people around the world live in poverty among wealthy urbanites. For mothers and children, these conditions can be particularly life-threatening and are stark reminders of the health disparities between rich and poor cities, according to the humanitarian nonprofit's report, which breaks down the top 10 best and worst countries as follows:

(Chart: Courtesy SaveTheChildren.org)

“One of the worst places in the world to be a mother is in an urban slum,” Margaret Chan, director-general of the World Health Organization, writes in the report’s foreword.

Every day, 17,000 children around the world die before they turn five, and the death rate among children and mothers is now higher in poor urban areas than in rural areas of developing nations. The poorest urban children in developing nations are twice as likely to die compared with the richest, according to the report. Many struggle to survive on the outskirts of large cities, living in urban slums and shantytowns or underneath bridges or along railroad tracks.

“These are the women and children left behind by this century’s spectacular socioeconomic advances,” Chan continues. “Far too often, even the simplest and most affordable health-promoting and lifesaving interventions—like immunizations, vitamin supplements, safe drinking water, and prenatal check-ups—fail to reach them. Their plight is largely invisible. Average statistics for health indicators in cities conceal the vast suffering in slums and other pockets of poverty in rich and poor countries alike.”

In urban slums in Nairobi, Kenya, for example, mothers and children die at a rate 50 percent higher than the national average. That disparity is reflected in similar statistics from urban slums in Latin America, Asia, India, and elsewhere. The report also found that poor children in “almost every city face alarmingly high risks of death.” For example, in Bangladesh, Cambodia, Ghana, India, Kenya, Madagascar, Nigeria, Peru, Rwanda, Vietnam, and Zimbabwe, children in urban slums are three to five times more likely to die than their counterparts in more affluent urban areas.

These death rates are the result of “disadvantage, deprivation and discrimination,” according to the report. Overcrowding, poor sanitation, and food insecurity are characteristics of urban slums that leave young mothers and their children more vulnerable to health problems. While there are more health care facilities in urban areas, they are often too expensive, and many disadvantaged people face discrimination when they try to seek care.

The rankings are representative of broader social implications too—11 of the countries at the bottom of the list are plagued by war and political instability, while the Nordic countries at the top of the list are characterized by a history of peace and prosperity.

Some of the report’s findings hit close to home, with the U.S. ranking 33rd overall. When compared with other capital cities in wealthy countries, Washington, D.C., has the highest infant mortality rate, at 6.6 deaths per 1,000 live births in 2013. The data also revealed that children born in the city’s poorest neighborhood, Ward 8, are 10 times more likely to die before their first birthday than children born in Ward 3, the city’s richest neighborhood.

But progress has been made. As Chan points out, the number of annual child deaths previously topped 10 million for decades, but that number has been cut in half since 1990. The same number of children who die each day are now being saved, and deaths related to pregnancy and childbirth have dropped almost 50 percent thanks to factors such as the use of modern contraception, better prenatal care, and the availability of free or subsidized health care.

“The world, especially the developing world, is becoming urbanized at a breathtaking pace,” writes Carolyn Miles, president and CEO of Save the Children. “Virtually all future population growth in developing countries is expected to happen in cities, resulting in a greater share of child deaths taking place in urban areas.”

Indeed, the percentage of the world’s population who live in cities is expected to rise by more than 10 percent by 2050.

“Sooner or later, you will see a mother and a child begging in the street of some major city,” Miles says. “Please don’t look away. It’s time for all of us to work to set things right—to reverse the urban disadvantage, once and for all.”