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A global ban on female genital mutilation was adopted

on November 26, 2012, for the first time by the United Nations General Assembly's human rights committee (Women's Health Policy Report November 28, 2012). The resolution states that the practice is harmful and a serious threat to women and girls' psychological, sexual, and reproductive health. It calls on the United Nation's 193 member states to condemn the procedure and launch educational campaigns to eliminate female genital mutilation. The committee also asked all countries to enact and enforce legislation against the procedure. The full General Assembly was expected to approve the resolution during the latter half of December (Associated Press, Guardian, October 27, 2012). Although not legally binding, the resolution reflects international concerns and carries moral and political weight. According to Amnesty International, the procedure is common in 28 African countries, as well as in Yemen, Iraq, Indonesia, and among some ethnic groups in South America. José Luis Diaz, Amnesty International's United Nations representative, said this was the first time the General Assembly's human rights committee has addressed the problem. “That a girl or young woman can be held down and mutilated is a violation of her human rights and, shockingly, an estimated 3 million girls are at risk each year,” he said.

The rate of cesarean delivery increased in Canada from 21.9 percent in 2001/2002 to 27.8 percent in 2009/2010, according to a recent national report by the Public Health Agency of Canada (Perinatal Health Indicators for Canada 2011, Ottawa, 2012). Both primary and repeat cesarean delivery rates increased during that period, from 16.1 percent to 19.7 percent and from 71.0 percent to 81.7 percent, respectively. The rate ranged from 8.1 percent in Nunavut to 31.4 percent in Newfoundland and Labrador. The database does not include information from Quebec. The 2009/2010 rate was slightly less than the rate for 2008/2009 (28.0%) in Canada. By comparison, the cesarean delivery rate in the United States for both 2010 and 2011 was 32.8 percent, and in England for 2010/2011 it was 24 percent.

In Canada the rate of initiation of breastfeeding remained stable at 87 percent in 2005, 87.9 percent in 2007/2008, and 87.3 percent in 2009/2010, according to the Public Health Agency of Canada (Perinatal Health Indicators for Canada 2011, Ottawa, 2012). The rates for 2009/2010 ranged from 61.5 percent in Newfoundland and Labrador to 97.2 percent in Yukon. The Western provinces had higher rates of breastfeeding than the Eastern provinces. By comparison, the breastfeeding initiation rate in the United States in 2009 was 76.9 percent, up from 74.6 percent in 2008. In Canada the rate of exclusive breastfeeding for at least 6 months increased from 20.3 percent in 2005 and 23.1 percent in 2007/2008 to 25.9 percent in 2009/2010. Exclusive breastfeeding also increased with maternal age; it was lowest at 13.8 percent for mothers aged 20-24 years compared with 33.3 percent and 28.4 percent in mothers aged 35-39 years and 40 years and over, respectively.

Australia had a record number of births in 2011 with a total of 301,617, compared with 297,903 in 2010, according to the Australian Bureau of Statistics (Births, Australia, 2011, Press release, October 25, 2012). Australia's total fertility rate for 2011 dropped slightly to .88 per 100 women, down from a recent high of 1.96 in 2008. Just over half (51%) of all births registered in 2011 were male babies, resulting in a sex ratio at birth of 104.1 male births per 100 female births. More Australian women over the age of 40 years are having babies than ever before—in 2011 a record of 12,800 babies were born to women over 40 years, up from 7,100 in 2001. The median age of all mothers for births registered in 2011 was 30.6 years, and the median age of first-time mothers in 2011 was 28.9 years, 62 percent of whom were married at the time of giving birth. The number of multiple births has increased consistently since the 1970s. In 2011 there were 4,560 confinements resulting in a multiple birth, of which 62 were triplets or higher order.

Severe complications from childbirth, although rare, are increasing in the United States, according to a new study by the Centers for Disease Control and Prevention (CDC) (Callagan et al. Obstet Gynecol 2012;1240:1029-1036). The study, which assessed hospital discharge records from 1998 through 2009, found that the rate of serious complications like heart attack, stroke, severe bleeding, and kidney failure during or after childbirth nearly doubled during that time period. The number of women with severe complications rose by 75 percent during the study period, reaching 129 cases per 10,000 women who gave birth in hospitals in 2008 and 2009. In addition, the number of complications during postdelivery hospital stays increased by 114 percent, totaling 29 cases per 10,000 women in 2008 and 2009. Dr. William Callaghan, lead author of the study, said the research did not assess reasons for the increase. However, he noted that more women are giving birth at older ages, are obese, or have certain health conditions, such as high blood pressure and diabetes, that could put them at risk for complications. A separate CDC study found that between 1993 and 2006, minority women accounted for 41 percent of all births in the United States, but 62 percent of all pregnancy-related deaths. The study showed that black women's maternal mortality ratio was four times that for white women, with 32 to 35 maternal deaths per 100,000 births among black women (A. Norton, Reuters Health, October 23, 2012).

Canadian health care is not meeting the needs of rural maternity care providers and patients because of reduced or eliminated service levels, leading to increased stress, personal costs, and negative delivery outcomes. This finding is addressed in a recent Joint Position Paper on Rural Maternity Care, issued October 10, 2012, by the College of Family Physicians of Canada, the Society of Rural Physicians of Canada, the Society of Obstetricians and Gynaecologists of Canada, the Canadian Association of Midwives, and the Canadian Association of Perinatal and Women's Health Nurses (J Obstet Gynaecol Canada and Can J Rural Med, October 2012). According to the Position Paper, new approaches are needed to support collaborative, integrated, and safe care for mothers and newborns in rural Canada, and to support physicians and other health professionals in rural and remote communities. The paper calls for medical training programs to incorporate competencies specific to rural maternity care, such as interprofessional work, collaborative practice, and a commitment to ongoing learning. “The goal is to provide care that is collaborative, woman- and family-centered, culturally sensitive and as close to home as possible, while ensuring patient safety,” says Dr. Kate Miller, principal author and chair of the Society of Rural Physicians of Canada's Maternal Newborn Committee. “It's time to invest in and implement the necessary changes to the health care system and maternity care training programs to establish and support rural maternity care services in Canada.”

The preliminary infant mortality rate for 2011 in the United States was 6.05 per 1,000 live births, which was not significantly different from the final 2010 rate of 6.15, according to the National Center for Health Statistics (Deaths: Preliminary data for 2011. Natl Vital Stat Rep 2012;61(6):7-8). The mortality rate of 11.42 per 1,000 live births for black infants was more than twice the rate of 5.11 per 1,000 live births for white infants.

The preterm birth rate fell for the fifth consecutive year in 2011 to 11.72 percent, which was 2 percent lower than the 2010 rate (11.99%), and 8 percent lower than the 2006 peak (Births: Preliminary data for 2011. Natl Vital Stat Rep 2012;61(5):5-6). The preterm birth rate rose by more than one-third from 1981 to 2006. Although the lowest level in more than a decade, the 2011 rate of preterm birth is still higher than rates reported during the 1980s and most of the 1990s. The 2011 low-birthweight rate was 8.10, down slightly from 8.15 percent in 2010. The low-birthweight rate (the percentage of infants born at less than 2,500 g or 5 lb, 8 oz) increased more than 20 percent from the mid-1980s through 2006, but has declined slowly, by 2 percent, from 2006 to 2011.

More than 100 mothers have died in childbirth in London in the last 5 years, twice the rate in the rest of the United Kingdom (J. Laurance, The Independent April 30, 2012). There were 11 deaths in 2005-2006, compared with 29 in 2010-2011. Births in London have risen by 27 percent in the last decade from 106,000 in 2001 to 134,000 in 2011, but numbers of midwives and doctors have not kept pace. Cathy Warwick, Chief Executive Officer of the Royal College of Midwives, said: “London still has some of the worst shortages of midwives across the country. There are more women facing more complex pregnancies creating a difficult situation. We need to target resources at women who need more support.” Two inquiries have been held into the high maternal death rate in London in the last 4 years and both have found maternity services wanting compared with the rest of the United Kingdom. One review, covering January 1, 2009, to June 30, 2010, was conducted by the Centre for Maternal and Child Enquiries, and found London's maternal mortality rate to be substantially higher than that of the rest of the country—19.3 per 100,000 maternities versus 8.6. The latest figures were obtained by Susan Bewley, professor of complex obstetrics at Kings College London and Angela Helleur of the National Health Service London and published in The Lancet (2012;379:1198). The maternal death rate in London has risen from 9.1 per 100,000 maternities in 2005-2006 to 21.6 per 100,000 in 2010-2011. Speaking to The Independent, Professor Bewley said that the number of deaths was small relative to the number of births, but maternal mortality was a sensitive measure of health care quality. Risks were higher in older mothers and linked with obesity, poverty, ethnic minorities, immigration, and twin pregnancies (after in vitro fertilization), all of which were more common in London than in the rest of the country.

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