Iwill never forget the grief etched on Suraj’s face. It was in February 2009, and I was interviewing the middle-aged laborer in the Indian state of Uttar Pradesh, doing research for No Tally of the Anguish, a Human Rights Watch report on maternal deaths in India. In a quiet voice, Suraj recounted the death of his daughter Kavita, soon after she gave birth:

Sadly, the pain I saw on Suraj’s face is far too common in India, and Kavita’s case is not isolated one—neither in India, nor in many other parts of the world.

Childbirth should evoke images of joy and celebration, not death or disability. Yet, every year, more than 350,000 women and girls die because of pregnancy, childbirth, and unsafe abortions. A majority— as many as three-fourths of such deaths—are preventable. Many more women are disabled or injured from childbirth. Between 50,000 and 100,000 new incidents of obstetric fistula (tissue damage between the vagina and the bladder or rectum leading to incontinence) are detected annually. Other long-term consequences include uterine prolapse (weakened muscles after childbirth leading to displacement of the uterus), infertility, and depression; short-term complications include hemorrhage, convulsions, cervical tears, shock, and fever.

These preventable deaths and disabilities are a disheartening reminder of the disparities in access to quality health care. Nearly 99 percent of all preventable maternal deaths and disabilities occur in sub-Saharan Africa and South Asia. According to the latest global estimates for 2008, Afghanistan, Bangladesh, India, Indonesia, Pakistan, the Democratic Republic of Congo, Ethiopia, Kenya, Nigeria, Sudan, and Tanzania together accounted for 65 percent of the world’s maternal deaths.

Much research has already been done into the causes of maternal deaths and injuries.