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Pregnancy and childbirth can be a beautiful time in a woman’s life, but it can also be one of the most challenging.

At worst, it’s heartbreaking.

Every day 830 women and 7,000 newborns around the world die from preventable life-threatening conditions and complications.

Almost all these deaths have occurred in developing countries, where healthcare services are dire or conflict is rife.

Many of these deaths occur in rural and remote regions, and are preventable with better access to clean and safe equipment, medication, and well-trained health workers who can provide immediate support and advice, or referrals, to women when needed.

World Health Organisation data shows the most common complications – accounting for 75% of maternal deaths – include: severe bleeding (usually after childbirth); infections (usually after childbirth); high blood pressure during pregnancy (pre-eclampsia and eclampsia); complications during delivery; unsafe abortions; and diseases such as malaria and AIDS.

The biggest killers of newborns include prematurity, complications during birth, or infections such as pneumonia and sepsis.

So where are the most dangerous places for a woman to be pregnant and give birth?

Pakistan

This south Asian nation, sandwiched between war-torn Afghanistan and bustling India, has long been marred by political, social and economic challenges, including gender inequality, terrorism and conflict, poverty, and illiteracy.

Women comprise more than half of the nation’s population, but have far fewer rights and opportunities than their brothers, sons, fathers and husbands.

The World Bank data shows about 60% of households are in regional or rural areas, where there is no or little access to healthcare services, support and advice, making pregnant women and their newborns one of the most vulnerable sectors of society.

According to UNICEF, Pakistan’s newborn mortality rate is the worst in the world, at 45.6 deaths per 1,000 live births. In comparison, the rate in Australia is 2.2 deaths per 1,000 live births.

Neonatal sepsis and infections, pre-term birth complications, birth asphyxia and birth trauma make up the top 10 causes of deaths in the country, according to the World Health Organisation.

Sierra Leone

This minerals-rich nation, well known for its diamonds trade, on the African west coast is one of the most dangerous places for a woman to be pregnant.

According to the most recent UN data, Sierra Leone has the world’s highest maternal mortality ratios in the world, at 1,360 deaths per 100, 000 babies born. This is equivalent to eight maternal deaths a day.

It’s estimated up to 6% of women in Sierra Leone will die as a result of maternal causes, such as severe bleeding, sepsis and hypertension, during their reproductive life.

Like Pakistan, war and conflict has long marred development in Sierra Leone. Poverty is widespread and it’s estimated about 60% of the population lives below the poverty line.

Between 2014 and 2016 the nation – along with its neighbours, Liberia and Guinea – also faced the worst Ebola outbreak in history. The epidemic killed more than 11,000 people.

A long history of poverty, disease and conflict has taken a toll on Sierra Leone’s health and prosperity.

Across the country quality healthcare services and workers are few and far between, impacting the most vulnerable members of society – pregnant women and their babies.

To mark International Day of Non-Violence, ChildFund has released a new report highlighting the vital support that its gender-based violence hotline is providing to women and families in Papua New Guinea.

PNG experiences some of the worst statistics for violence against women in the world. While reliable data is scarce, it is estimated that more than two thirds of women experience physical and/or sexual violence in their lifetime. Human Rights Watch estimates that 70 percent of women experience rape or assault in their lifetime, and in research carried out with men in PNG’s Bougainville, 62 percent of men reported having perpetrated rape against a female.

In 2015, ChildFund PNG and its partners established the country’s first ever Family and Sexual Violence Counselling Hotline – 1-Tok Kaunselin Helpim Lain. As well as telephone counselling and safety planning, counsellors provide information and referrals to a wide range of gender-based violence (GBV) service providers and face-to-face counselling services including police, medical services, safe houses and legal support.

In emergency cases, counsellors can talk to the police on the client’s behalf, then call the survivor back to assure her that help is on the way. The hotline is available nationally and offers callers three languages – English, Tok Pisin and Hiri Motu.

In PNG, where services are scarce (87 percent of the population of PNG live in rural and remote areas) but where mobile phone ownership is high, a telephone counselling service is critical. In fact, for survivors and perpetrators living in remote areas, telephone counselling is the only accessible intervention.

In the two years since its launch, the hotline has received calls from around 8,000 women, men and children. Analysis of call data in 1-Tok Kaunselin Helpim Lain: A report on the first two years of operation has found that:

  • family and sexual violence, followed by relationship issues and child welfare concerns are the top presenting issues for callers;
  • in more than half of the calls relating to incidents of GBV, the perpetrator was an intimate partner; and
  • one-quarter of all callers were provided with crisis counselling and safety planning.

Interestingly, almost half (48%) of the calls to the hotline are from males. This is because men in PNG are typically less likely than women to seek help, reflecting stereotypical gender roles. As such, the hotline provides an anonymous service to men seeking help.

In Maryanne’s case, the hotline provided a life-saving service when she was threatened with violence by her partner. Counsellor Grace used the 1-Tok Helpim Lain’s service provider database to find the number of the nearest Police Station. The police arrived within 15 minutes, escorted Maryanne to safety and apprehend her husband. In the days following the event, Grace provided ongoing counselling, helping Maryanne with a range of options to improve the situation for her and her children.

With increased promotion of the service across the country, calls to the 1-Tok Helpim Lain are increasing and the helpline will continue to play a critical role in answering calls for help, providing counselling and making referrals to a range of services.

The 1-Tok Kaunselin Helpim Lain – 7150 8000 – provides toll-free confidential telephone counselling, information and support for anyone experiencing gender-based violence in Papua New Guinea. ChildFund PNG is the lead implementing partner of the service, working in close partnership with the Family and Sexual Violence Action Committee and FHI 360. The service is funded by the New Zealand Ministry of Foreign Affairs and Trade (MFAT), with contributions from ChildFund Australia and ChildFund New Zealand.