alcohol and drug abuse and mental illness, have been cited as important factors (Brown, 2001). While such issues affect older adults as well, they are particularly relevant among the young because the individual developmental transitions experienced during this phase of life can be full of stress and uncertainty. Increased access to the means to commit suicide may also be a factor in rising rates in some countries (Brown, 2001; Eckersley and Dear, 2002). For example, the ingestion of powerful and readily available pesticides is the most common method used by rural Chinese women (Hannum and Liu, 2005).

Maternal Mortality and Morbidity

Maternal mortality and morbidity are among the most significant threats to the health of young women in developing countries. Maternal mortality comprises a substantial proportion of deaths to young women in all developing country regions except East Asia (see Table 4-2). The proportion of deaths attributable to maternal causes ranges from 25 percent in Northern Africa and the Middle East to 16 percent in Africa, Latin America, and South Asia, to 6 percent in East Asia. In addition, nonfatal complications associated with pregnancy and childbirth are common and not only affect health in the short term, but they can cause or make worse some long-term morbidities, such as obstetric fistula, uterine prolapse, anemia, reproductive tract infections, and infertility (National Research Council, 1997a).

The most recent global estimates put the maternal mortality ratio (i.e., maternal deaths per 100,000 live births) in developing countries at 440. Another measure, the lifetime risk of maternal death, shows that the chance that a woman in a developing country will die of maternal causes is 1 in 61 in developing regions compared with 1 in 2,800 in developed regions. There is also enormous variation across the developing regions, with the lifetime risk reaching 1 in 16 in sub-Saharan Africa and 1 in 840 in East Asia (World Health Organization, 2003). Maternal deaths are those that occur during pregnancy and up to 42 days after birth. About 80 percent of these deaths are due directly to maternity; the most common cause is hemorrhage, followed by sepsis and complications of unsafe abortion, hypertensive disorders, and obstructed labor. The remaining 20 percent of deaths are due to conditions that are aggravated by pregnancy but may be present prior to pregnancy, such as diabetes, anemia, malaria, and increasingly HIV/AIDS.

As in the case of other cause-specific mortality data, estimates of maternal mortality are often based on partial information of variable quality, so trends can be inferred only cautiously and at the most general level. Trends related specifically to young women are not available, but a United Nations



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