PBS高端访谈:全球最佳和最差的生育地点

 　　GWEN IFILL:We turn now to a new report which ranks the countries where mothers and their children are at the most and the least risk.

　　The international nonprofit Save the Children finds Norway the healthiest for the third year in a row, the worst, the West African nation of Niger. It replaced Afghanistan, which moved up one spot from last year. The United States ranked 25th.
　　For more on the report, we're joined by Save the Children president and CEO Carolyn Miles.
　　Welcome, Ms. Miles.
　　CAROLYN MILES, president, Save the Children:Thank you, Gwen.
　　GWEN IFILL:Give us a sense of what measures you're using to come up with these rankings.
　　CAROLYN MILES:Well, we looked at a wide variety of measures, really looking at things like child mortality, maternal 1 mortality, the education of women and girls, economic empowerment of women, even the political involvement of women, because all of those give us a good indicator 2 of the status of women in those countries, which really impacts what it's like to be a mom there.
　　GWEN IFILL:So, what. . .
　　CAROLYN MILES:We also looked at things like maternity 3 leave, so all sorts of factors.
　　GWEN IFILL:So what's the difference in the end in the rankings between the top 10 and the bottom 10?
　　CAROLYN MILES:Well, it's interesting.
　　They're really kind of almost a mirror of each other. So all those indicators 4 I talked with—about are great for the top 10, and they're all quite poor for the bottom 10. So an example would be if we compare Norway and Niger, as you said, number one and number 165.
　　So, in Niger, only one in three births are attended by any kind of skilled attendant. And some of these births are actually women giving birth all by themselves, whereas, in Norway, virtually every birth is attended by a skilled birth attendant.
　　Things like education rates for girls, so about four years on average in Niger, 18 years in Norway. Probably, for me, as a mom, the most shocking statistic 5 actually from this year's report is that, in Niger, virtually every mother will lose a child before the age of 5, will lose one of her children. So that to me, as a mom, is a pretty shocking statistic, so really across the board.
　　GWEN IFILL:It's a pretty shocking—it's pretty shocking statistics. And I wonder how much of this is also driven by malnutrition 6 not only involving the mothers, but also the children.
　　CAROLYN MILES:Yeah, we really looked at malnutrition this year as a huge factor and looked at hunger; 170 million kids across the world are malnourished. That's about one in four children.
　　And that has a big, big impact on child health. So of the seven-and-a-half million kids that die under the age of 5, about a third of them are malnourished. So when a child gets sick, they die from very common illnesses if they're malnourished.
　　GWEN IFILL:I was also interested in something in the report about educational attainment 7 for girls. That's—you wouldn't think about that as having to do with health, necessarily.
　　CAROLYN MILES:Well, the reason it's a key indicator in this report is that we have actually done a lot of work on this issue. The longer you keep girls in school, the longer they delay having their first child. And that child will be much healthier.
　　A girl who has a baby at 14 is a much higher-risk pregnancy 8 and a much higher risk for that baby than if the girl waits until she's 17 or 18. And if she stays in school, it's much more likely she is going to wait until she's older. So that's why girls' education is actually so important.
　　GWEN IFILL:I was also interested in the—in the status of Afghanistan which was dead last, last time you took this report, and now has moved up. What happened in Afghanistan?
　　CAROLYN MILES:Well, there actually are some good bright spots in this report, and Afghanistan is one of those.
　　Afghanistan did move up. It doesn't sound like a lot, but moving up from last to not being last anymore is big. And a lot of that was driven by education rates, actually. So the years and years that people have been working on getting girls into school is really starting to show up in terms of the health of mothers and of babies there. So that was a big change.
　　GWEN IFILL:And also the—and also the proliferation of community health centers from—I think from 2,500 in 2008 to 22,000 now, that's a lot.
　　CAROLYN MILES:That's right.
　　And a lot of these health centers are in the places where moms and babies do die, kind of at the end of the health system, if you will, at the end of the road, really remote areas where these moms are oftentimes giving birth at home. So, having a health clinic close at hand really saves lives.
　　GWEN IFILL:And, finally, I have to ask you, why is it that the U.S. ranks 25th? You would assume, if it wasn't number one, it would at least be in the top 10 or the top 20.
　　CAROLYN MILES:Yes. I think the number 25 for the U.S. is really surprising. Actually, the U.S. moved up six spots this year, so we were 30—the U.S. was 31 last year.
　　But we still have very high rates, relatively 9, of maternal mortality in the country. One in 2,100 births result in the death of the mother. And we still have some very high rates of child mortality as well. So it's because of poverty in the United States, the big gap between health care that's available for well-off women vs. very poor women, and that's really a huge gap still in the United States.
　　GWEN IFILL:Carolyn Miles of Save the Children, thank you so much.
　　CAROLYN MILES:Thank you, Gwen.
　　GWEN IFILL:You can find a slide show of the best and worst places for maternal and child health on our website.