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Save the Children lists 10 countries where motherhood is a daily, life-or-death struggle. This week, Save the Children released its annual report on the State of the World's Mothers, which ranks the status of mothers in countries worldwide using a wide set of criteria including female life expectancy, lifetime risk of maternal death, women's economic equality, child mortality, and working conditions for mothers.

Topping this year's index is Norway, the developed country with one of the highest ratio of female-to-male earned income, the world's highest contraception rate, and one of the most generous maternity leave policies anywhere. Northern Europe dominated the top 10 with the United States coming in at a not particularly impressive 31st, thanks in part to its 1 in 2,100 maternal death ratio -- the highest of any industrialized nation-- and its maternity leave policies, the shortest and least well-supported financially of any wealthy nation.

This Mother's Day, it's worth remembering the struggling moms in the following 10 countries, who make up the bottom of the list.
Spencer Platt/Getty Images In the world's hardest country to be a mother, a typical woman has fewer than five years of schooling and is only expected to live to 45. Fewer than 16 percent of women use modern contraception, and one child in five dies before reaching age 5. At that rate, every mother in Afghanistan is likely to suffer the loss of at least one child.

Measures to improve women's health and safety during the NATO-led occupation have often come under attack from religious extremists. In one well-publicized instance, the government had to take control of the country's women's shelters after a popular broadcaster suggested they were fronts for prostitution.

Afghanistan's strictly enforced gender separation combined with the  lack of midwives and female doctors in the country also frequently prevents mothers from getting the medical care they need. A typical woman receives fewer than four years of education in Niger. Only a third of births are attended by a skilled health professional, resulting in one of the world's highest infant mortality rates.

With the assistance of UNICEF, the country recently began offering free prenatal care like insecticide-treated bed nets, medicine to prevent malaria and tetanus, as well as vitamins. With the average woman in Niger giving birth to seven children and most living far from a health center, help can't come too soon. Only two girls for every three boys are enrolled in school in Guinea-Bissau, one of the lowest rates in the world. Women, on average, can expect fewer than five years of education, and only 6 percent of women have access to modern contraception.

It's not uncommon for women to be married as young as 13 or 14, and the World Bank estimates that nearly one-third of homes are polygamous.  Pregnant women in Guinea-Bissau often work right up until the time they begin feeling labor pains.
SEYLLOU/AFP/Getty Images In a country where women earn only about 25 cents for every dollar a man makes and the proportion of women taking a role in government is one of the lowest in the world, it's not surprising that gender roles in marriage, too, would be drastically skewed. Yemen has no minimum age for marriage, and the taking of child brides as young as 8 is widespread.

Mothers are often powerless to prevent their daughters from being married off, as Yemeni law gives custodianship to fathers.
Brent Stirton/Reportage by Getty Images Motherhood in Chad is riddled with illness. Fewer than 15 percent of births are attended by skilled medical personnel and 1 in 14 women die during childbirth. As of 2007, 18,000 pregnant women were living with HIV in the country and 19,000 children were living with the virus -- the vast majority of whom received it from their mothers. The Congo has been torn by the use of rape as a weapon, with long-term impacts on mothers and children both physically and psychologically. More than 40,000 women were raped by fighters in the country between 1998 and 2004 alone -- the real number is likely far higher, as most go unreported.

There are no reliable statistics of the number of children born from rape in the Congo, where abortion is banned by law, but it's thought to be in the thousands. Rape victims as well as their children often face severe social discrimination. Violence against women is pervasive in Eritrea, including all forms of sexual violence. Eritrean women are required to participate in national service but are often subjected to sexual harassment or abuse after being drafted. Those who become pregnant during their military service as a result of sexual abuse are discharged and often subjected to social ostracism when they return home.

According to the U.S. State Department, authorities often respond to allegations of rape by encouraging the perpetrator to marry the victim. An estimated 85 percent of women between 15 and 49 in Mali have undergone some form of genital mutilation. The life expectancy for women is only 50, and a third of Malian children under five are moderately to severely underweight.

Reforms to the country's health sector in recent years have helped cut the maternal mortality rate, but it remains high, with women facing a 1 in 22 lifetime risk of death. The government has focused efforts on encouraging women to attend checkups during their pregnancies. Things are bad enough in Sudan, where around 42 percent of the population has no access to clean drinking water, but conditions in the soon-to-be-independent nation of South Sudan (not included in this ranking) are particularly dire. There are 509 maternal deaths per 100,000 births in the south -- the highest rate in the world.

Fewer than 5 percent of births are attended by health professionals. With little in the way of central government or public health infrastructure, the world's newest nation has an unfolding crisis on its hands. The average life expectancy for women in CAR is only 49 and the average woman receives only five years of education. Amnesty International has reported the widespread use of rape as a weapon during the country's' 2002-2003 civil war. Forty-two percent of girls between 15 and 19 years of age were married, divorced, or widowed. Wives generally have few legal rights over the raising of their children. Maria Susana Diaz

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