Where Childbirth Can Mean Death

Nazreen Khatoon, a 25-year-old farmer in the eastern Indian state of Assam, gave birth to a boy in March. Just two weeks later, she returned to a local government hospital suffering from severe anemia. Khatoon’s condition is all too common in Assam, one of India’s poorest states, where the last national family health survey in 2006 showed that 70% of women suffered from anemia. The crucible: the state’s tea plantations, which produce a sixth of the world’s tea supply, and where anemia as well as malnutrition are endemic.

During the harvesting season, workers fan out across the plantations to pick more than 20 kg of tea leaves per person for wages that in 2014 stood as low as $1.50 a day. To keep earning, female workers carry tea leaves in baskets or bags slung over their backs months into their pregnancies. Already weak, and with few public-health resources to draw on, too many of these women die from complications during pregnancy or childbirth.

As a result, Assam has the highest maternal mortality rate in India, a country that, overall, accounted for some 50,000 of the 289,000 maternal deaths worldwide in 2013. From 2011 to 2013, 167 Indian women died for every 100,000 live births. In Assam the figure was nearly double that at 300…

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