May 7th, 2010
12:00 AM ET

Five best and worst places to be a mom

An Afghan mother with her two sons.

by Madison Park
CNNhealth.com writer/producer

What are the best and worst countries for moms? Just in time for Mother’s Day, Save the Children has ranked the countries with the best and worst maternal health.

Norway topped the non-profit advocacy group’s list, with its low infant mortality rates and high contraceptive prevalence followed by other Western countries.  Meanwhile sub-Saharan African countries and Afghanistan ranked last.

The health rankings were based on lifetime risk of maternal death, percentage of women using modern contraception, the presence of a skilled attendant at birth, and female life expectancy, derived from United Nations and World Health Organization statistics.  The Mothers’ Index compared the well-being of mothers and children in 160 countries.

For the full report: 2010 State of the World's Mothers (PDF)

The United States ranked number 28.  Why so low?

Save the Children explains: “One of the key indicators used to calculate well-being for mothers is lifetime risk of maternal death. The United States’ rate for maternal mortality is 1 in 4,800 – one of the highest in the developed world.”

It also stated that “a woman in the Unites States is more than five times as likely as a woman in Bosnia and Herzegovina, Greece or Italy to die from pregnancy-related causes in her lifetime and her risk of maternal death is nearly 10-fold that of a woman in Ireland.”

Around the world, there are startling statistics: 50 million women in the developing world give birth without professional help and 8.8 million children and newborns die from easily preventable or treatable causes.

The risk of a woman dying from pregnancy or childbirth-related causes in Niger is 1 in 7.  The risk is 1 in 8 in Afghanistan and Sierra Leone.  Compared to Ireland (which ranked 11), that risk was 1 in 47,600.

Top 5 places for mothers:

1. Norway
2. Australia
3. Iceland
4. Sweden
5. Denmark

Worst 5 places for mothers:

1. Afghanistan
2. Niger
3. Chad
4. Guinea-Bissau
5. Yemen

See the full list (PDF)

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation

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soundoff (44 Responses)
  1. Peter Stirling

    Interesting article but the real story seems to be the TEN-FOLD increased risk of maternal death in the US compared with a country like Ireland.

    Why is this? Who are these mothers? Did they have healthcare? Are US doctor's inducing more? Doing unnecessary C-sections? Are these just homeless women?

    It seems like a disgraceful statistic. Maybe Dr. Gupta can shed some light.

    May 7, 2010 at 10:09 | Report abuse | Reply
  2. Rosira Palmer

    The worst places should be listed also based in what their economies can offer. The countries mentioned above maybe do not have a structure to support anything much different than that. In other hand, here in US is hard to understand how a society so concerned about children only gives 4 weeks or 6 weeks (C-Section) of maternity leave with full salary.
    I came from Brazil were there are still a lot of things to be improved but I need to recognize that the opportunity to stay 5 months at home with my first baby was very important to the family.

    May 7, 2010 at 10:40 | Report abuse | Reply
  3. danielle

    Probably has something to do with obesity related illnesses/conditions

    May 7, 2010 at 10:45 | Report abuse | Reply
  4. Kaylan

    I think the article needs to include overall care and living status for mothers, not just pregnancy success. If a mother is alone or can not support themselves, they will suffer immeasurably, as well as the children. This needs to be included in any study on location for mothers.

    May 7, 2010 at 10:47 | Report abuse | Reply
  5. Melissa

    I can say that more and more women are chosing alternate places to give birth such as at home and with no doctors around. Most women are doing this as a cost saving measure, but it can be very dangerous if there is a problem.
    I can tell you I am a poster child why doctors tell you not to have a child at home. I was in the hospital luckily when I gave birth. I had extreme pain I couldn't move and no medication would help the pain; I had to have emergency surgery. An artery got torn somehow during delivery and I had massive internal bleeding. They were sure if I would make it, if I would need a blood transfusion, and prior to going into surgery they weren't sure where the bleeding was coming from. if I hadn't been at the hospital I very likely wouldn't be here today and my son would be without a mother.

    May 7, 2010 at 10:48 | Report abuse | Reply
  6. femspotter

    Peter Stirling, I am not one to defend CNN and clearly this story could be elaborated upon; but all the information you seek is in the full report:

    "Why doesn’t the United States do better in the rankings?
    The United States ranked 28th this year based on several factors:
    ••One of the key indicators used to calculate well-being for mothers is lifetime risk of
    maternal death. The United States’ rate for maternal mortality is 1 in 4,800 – one
    of the highest in the developed world. Thirty-five out of 43 developed countries
    performed better than the United States on this indicator, including all the Western,
    Northern and Southern European countries (except Estonia and Albania) as well as
    Australia, Bulgaria, Canada, Czech Republic, Hungary, Japan, New Zealand, Poland,
    Slovakia, and Ukraine. A woman in the Unites States is more than five times as likely
    as a woman in Bosnia and Herzegovina, Greece or Italy to die from pregnancy-related
    causes in her lifetime and her risk of maternal death is nearly 10-fold that of a woman
    in Ireland.
    ••Similarly, the United States does not do as well as many other countries with regard
    to under-5 mortality. The U.S. under-5 mortality rate is 8 per 1,000 births. This is on
    par with rates in Slovakia and Montenegro. Thirty-eight countries performed better
    than the U.S. on this indicator. At this rate, a child in the U.S. is more than twice as
    likely as a child in Finland, Iceland, Sweden or Singapore to die before his or her fifth
    ••Only 61 percent of children in the United States are enrolled in preschool – making it
    the seventh lowest country in the developed world on this indicator.
    ••The United States has the least generous maternity leave policy – both in terms of
    duration and percent of wages paid – of any wealthy nation.
    ••The United States is also lagging behind with regard to the political status of women.
    Only 17 percent of seats in the House of Representatives are held by women,
    compared to 46 percent of seats in Sweden and 43 percent in Iceland."

    May 7, 2010 at 10:49 | Report abuse | Reply
  7. Mike

    "It seems like a disgraceful statistic. Maybe Dr. Gupta can shed some light."

    I'm not surprised at all. The healthcare system's broken, that's not even up for discussion. The people who vote against healthcare reform are voting for keeping the United States as one of the least healthy countries of the developed world. We SHOULD be in that top 5, we COULD be in that top 5, but until the system gets fixed, until these selfish politicians drop the dog and pony "socialism" nonsense, it won't happen.

    May 7, 2010 at 10:50 | Report abuse | Reply
  8. DpackTX

    Well, doesnt that seem obvious ! Countries with and without money

    May 7, 2010 at 10:51 | Report abuse | Reply
  9. Kaylan

    For example, in many Arab countries, women are treated like second class citizens and abused without any justice system. Their children are even taken away from them since the male-based society rules.

    In China, women who have a child by accident when they are not suppose to (since they have one-child policy and their reproductive cycle is under govt scrutiny), are arrested by population police and forced into an abortion and also often sterilized against their will. If you ask me, that is the greatest nightmare and a very grave evil against women. They also take their babies away if they have more than one. One example. there was a news story about when milk was contaminated (formula) and women were using women who were able to breastfeed to feed their babies. In this story, the woman who was helping other moms had breast milk because she had recently given birth to her second child. she related that her child was taken away from her in the hospital and she has never seen her baby girl again. Talk about cruel!

    May 7, 2010 at 10:51 | Report abuse | Reply
  10. Deborah Dietrich

    I've read that our high C-section rate does play into this high maternal death rate statistic.

    I've also read that our high national obesity rate, with its associated risks of diabetes and high blood pressure, is a definite factor.

    Additionally, we have an increasing number of women delaying childbirth till later in life. These late-in-life pregnancy are also considered to be high-risk pregnancies with a higher mortality rate than women having their first born in their twenties rather than thirties or even forties.

    May 7, 2010 at 10:52 | Report abuse | Reply
  11. Futbol Czarina

    A few things come to mind regarding this article. Why is the US ranked so low for maternal health care? Perhaps it's the obesity factor, increased likelihood of higher order multiples due to fertility treatments, or the fact that the top 5 listed countries have a propensity toward physical fitness. It would be a good follow-up article to compare health factors post-pregnancy for every country in the world.

    May 7, 2010 at 10:56 | Report abuse | Reply
  12. Natalie Durkin

    Too many inductions, *way* too many C-sections for non-emergency purposes, poor eating habits, too many processed foods, stressful lifestyles, poor emphasis on prevention, obesity and all it's health risks, lack of access to quality care if uninsured (not poor- i.e. self-employed, pre-existing conditions– denied access to insurance)– the list goes on and on. It is a pitiful state of our nation's healthcare affairs.

    And as is all too often the case, the disparity in care often ends up on the side of women and children.

    And for those who think hospital births with doctors are the only safe way to go, please note that some of the highest ranked nations are midwife-based care systems (Britain, Ireland, Japan, Netherlands, to name a few). Not unsupervised, but you aren't necessarily cared for by an MD unless you are considered high risk or present with complications. We have lost the plot in this country by indoctrinating ourselves with the idea that more intervention is necessarily better. It saves lives when we need it, but childbirth– under normal circumstances– doesn't need to be considered the medical emergency it so often is in our society.

    May 7, 2010 at 11:07 | Report abuse | Reply
  13. Dr.Z


    I think you shoould read more about Arab countries or you should listen less to fox news. Maybe women in that part of the world don't have all of their right, but definitely they are not a second class as you mentioned. And what do you mean by “Their children are even taken away from them since the male-based society rules.” Really what you are saying is make no sense.

    May 7, 2010 at 11:17 | Report abuse | Reply
  14. Concerned reader

    A very poorly written article. Provides no substance as to why rates differ so much, other than leaving one to assume that money plays a large role in mortality stats. Do more homework next time!

    May 7, 2010 at 11:21 | Report abuse | Reply
  15. Lainie

    Melissa, your story is why the midwives I worked with had a VERY strict transport policy. If anything was not going well, be it pain or blood pressure, or meconium in the amniotic fluid, or simply lack of progress, they insisted that you go to the hospital. When my older daughter was born, I had pre-eclampsia, and the planned birth-center birth went to the standard delivery unit. When my son was born, we planned a home birth, but we transported, due to lack of progress. The little twit was born ten minutes after we got to the hospital- no problems, he was simply stubborn. My younger daughter was born at home with no complications.

    However, the overall issue is way beyond Melissa's case. It is my feeling, simply as a mom and a former midwifery student (I dropped out to take care of my own kids) that the key is good- not just adequate, but good) pre-natal and post-natal care. You'll note that the five countries listed at the top all have some form of nationalized health care. They also have far lower c-section rates than we do here in the US. There are a couple of factors working here: first, and over-reliance and overuse of fancy technology. The vast majority of births are unremarkable, and really don't need all of the machines. (For instance, if they use a fetal monitor, your chances of having a c-section go up- because they have you immobilized and laying on your back in bed- the very worst place to labor. They also are prone to false positives- indications of distress where there are none. Turning the wrong way can be enough to cause this.) Why do they over-use the machines? Here cause number two: It's called CYA Medicine. They use the machines to cover their on liability- so if something goes wrong, they can insist that they 'did everything they could'. And why do they do this? Because of the draconian insurance companies. Malpractice insurance is skyrocketing, and many OBs are quitting because they can no longer afford to practice. And if you have a claim against you, forget getting insurance at all. Fold up and go herd sheep.

    So there you go. Socialized medicine provides more complete pre-natal and post-natal care, and our insurance industry is forcing our medical professional to practice medicine in a way that is actually detrimental to their patients.

    Single-payer would circumvent both problems. But we'll never get it so long as the insurance industry and the political radicals (yes radical Republicans and Libertarians, I'm lookin' at you) have their knives to the throat of Congress. We need a change in campaign finance, and a chance in how PACs are allowed to work. Too much money is flowing in both for this political process to actually work to the benefit of the people.

    May 7, 2010 at 11:38 | Report abuse | Reply
  16. Valerie

    So basically, the whitest places in the world are the best places for women.

    Didn't need any study to tell us that!

    Lord, it's a good day for me to be Swedish! : )

    May 7, 2010 at 12:03 | Report abuse | Reply
  17. lapster

    United States 28th?? Utterly blown away over that (in a bad way).

    May 7, 2010 at 12:08 | Report abuse | Reply
  18. Juliet

    Melissa, I'm very sorry you had such a difficult time with your birth, but to say that home births are the source of our nation's depressing statistics about healthy mothers and babies – well, you're just completely wrong – and the statistics are on my side.
    First of all, the majority of home birth mothers don't choose a home birth b/c they can't afford a hospital birth. They choose it because they want a safe, intervention-free birth for themselves and their children. If I'd chosen a hosptial birth, I could have saved $, b/c my insurance would have paid. My insurance didn't pay for my midwife assisted home birth. I chose it, b/c statistically, it's what's safest for mother and baby. Statistically, C-Sections are the highest risk births, and another interesting statistic is that doula assisted mothers in hospitals and midwife assisted mothers in and out of hospitals require fewer C Sections. That indicates that it's perhaps not so much about the needs of the birthing mother as much as it is the "needs" of the person in the greatest role of support in her care that dictates which moms will get a C-Section. American OB's are C-Section and intervention-happy which puts both moms and babies at risk. The safest place in the world for 98% of moms and babies before during and after delivery is their own home.

    May 7, 2010 at 12:17 | Report abuse | Reply
  19. CountChocula

    So the main point of the article is that it's better to be a mom in a rich country than it is to be a mom in a poor country? Really; you needed to do an investigation to discover this information?

    May 7, 2010 at 12:33 | Report abuse | Reply
  20. Eric Nilson

    Having lived in Sweden, and having been a participant in the Swedish health system, I would say that the main difference between Sweden and the US , when it comes to pregnancy issues, is the ability for the mother AND the father to be home to relax (with pay), and get to know their new child. Preventative medical care is the norm in Scandinavia, whereas here in the US, it's more like reactive care. The Swedish health system makes allotments for mental and emotinal stress, and being the husband of a women who is 9 months pregnant with our second child, believe me when I tell you there is no more stressful time in most women's lives. Therefore, while Americans must keep plugging away, taking the fmla allotted 12 weeks (6 of which are unpaid), and father's are allowed no time to help out without losing pay, stress and worry become a factor. Whereas when my son was born in Stockholm, his mother didn't have to return to work for a year, while receiving 85% pay, and I was able to take five months off at 80%, and could have worked reduced hours for full pay until he turned three. Moral is, stress and lack of good preventative healthcare are probably very lage contributing factors to this statistic... but what do I know?

    May 7, 2010 at 12:36 | Report abuse | Reply
  21. Dan

    Dr. Z – Freedom House good enough for you? "The Middle East is not, of course, the only region of the world where women are, in effect, relegated to the status of second-class citizens." A high-ranking Iranian cleric said that women of loose morals cause earthquakes. Perhaps you should spend less effort blaming news organizations and more time reading actual news.

    May 7, 2010 at 12:37 | Report abuse | Reply
  22. Shawn Steketee

    I find this report to be one of the biggest arguments for Universal Health Care.

    May 7, 2010 at 12:49 | Report abuse | Reply
  23. Victor

    Let's do some reality check. What is are the birth rates of these so-called "best" and "worst" places to be a mom? Here is the data from the CIA factbook:

    1. Norway 1.78 children born/woman
    2. Australia 1.78 children born/woman
    3. Iceland 1.9 children born/woman
    4. Sweden 1.67 children born/woman
    5. Denmark 1.74 children born/woman

    Worst 5 places for mothers:

    1. Afghanistan 5.6 children born/woman
    2. Niger 7.75 children born/woman
    3. Chad 5.31 children born/woman
    4. Guinea-Bissau 4.65 children born/woman
    5. Yemen 5 children born/woman

    The bottom line, women in countries where it's great to be a mom don't want to be moms. Women in countries where it's terrible to be moms are becoming moms at an increasing rates. The countries where women have less than 2 kids on the average are slowly going out of business, and their retirement systems, supported by the taxes of the working population, will soon collapse due to the lack of working population.

    It's also clear why the US didn't make the list: it's birth rates, 2.05 children born/woman, are about right, neither too large, nor too small, but obviously not small enough for the types who compile these lists to be included on the list of "best" places to be a mom. Yet American women are happier moms than those in Sweden.

    May 7, 2010 at 12:54 | Report abuse | Reply
  24. Russ

    Yea, I am sure it has something to do with our obesity epidemic – diabetes or other obesity problems joined with pregnancy.

    May 7, 2010 at 13:34 | Report abuse | Reply
  25. HansGruber

    Dan- you said:" A high-ranking Iranian cleric said that women of loose morals cause earthquakes". insinuating that this "proves" that women are second class citizens in Arab countries, but in comparison, A high-ranking United States of American cleric -Pat Robertson- said "Haiti's earth quake was the cause of Haitians previous deal with the Devil". Does statements like this "prove" that Americans are ignorant- No. It only shows that idiots exist in every country.

    May 7, 2010 at 13:38 | Report abuse | Reply
  26. william

    This highlights that the USA may have the highest medical technology yet it has the lowest, among industrialized nations, in overall in Health Care System- and about a standing of 30th out of 200th overall.

    May 7, 2010 at 13:45 | Report abuse | Reply
  27. Chelsey Megan

    Watch the documentary by Abby Epstein “The Business of Being Born.” It gave new insight to the way America operates and views childbirth. It was amazing and inspiring and relates 100% to this article. You can watch it on Netflix for free ☺

    May 7, 2010 at 13:50 | Report abuse | Reply
  28. Cali

    Victor, why makes you suggest that American moms are happier than mothers in Sweden?

    May 7, 2010 at 15:03 | Report abuse | Reply
  29. Colin Thurman

    Perhaps the increased rate of infant and maternal health risks during pregnancy are more a result of epidemic drug and alchohol abuse in the U.S. rather than poor health care.

    May 7, 2010 at 15:04 | Report abuse | Reply
  30. Alice

    Many of the suggested reasons for the US not being among those with best maternal statistics are reasonable if not probable. I think what william said needs to be underlined: Our technology enabled the physician and hospital to save Melissa's life (see above) for which we can be thankful. However, when it costs so much money to be prepared for the very unusual situations of a FEW to the detriment of giving prenatal care and basic health care to the MANY women whose life experiences haven't taught them their tremendous value, then we have to expect to lose many women. Their babies, those who survive, are motherless. Young women without ongoing, developmental health care have incipient if not overt high blood pressure and diabetes both of which cause higher mortality rates. We, as a country, need to put our funds into high quality health care for all, not highly technologic medical care ready to save a few. Thanks.

    May 7, 2010 at 17:12 | Report abuse | Reply
  31. Michelle

    Chelsey Megan I absolutely agree! “The Business of Being Born" Is a wonderful documentary! it really opened my eyes on how our healthcare system handles birth. Its very informative and totally relates to the article!

    May 7, 2010 at 17:48 | Report abuse | Reply
  32. Ina May Gaskin

    I agree with Natalie Durkin, Lainie, & Juliet. I became concerned about this problem when I read a document published by the Centers for Disease Control (CDC) in 1998 that said the US's lowest maternal death rate was in 1982 (!). There has been no improvement since; rather, the death rate for mothers has been rising, especially during the last 10 years. It tripled in California between 1996 and 2006, and much of this increase was due to rising c-section complications. The CDC article (Sept. 4 issue of MMWR) also stated that there is a large underreporting/misclassification factor, which means that the actual rate could be as much as three times higher than that which is officially reported.

    This is only one reason why there is so much guessing about the causes for the high death rate. The US has always been behind other wealthy countries. I have many references and books written by doctors in 1930s or 1940s, that put the US behind the European nations who all have more midwives than obstetricians—the best way to avoid unnecessary surgery.

    http://www.rememberthemothers.org is my website devoted to honoring women who have died from pregnancy-related causes—whether preventable or not. My goal with the project is to take the first step: to gather data in a uniform way in every state (at present, this is voluntary, so many maternal deaths are not classified as such) and to make it a felony to intentionally falsify the cause of death on a death certificate. I sometimes see "cause of death" filled out simply as "cardiac arrest." Presumably, this is done because there is no penalty for a non-answer.

    Until we gather all the data (as the UK does in its Confidential Enquiries into Maternal Deaths http://www.cemach.co.uk), we will continue to guess at causes for all these unnecessary deaths. We should be taking the obvious steps necessary to gather accurate and complete information.

    May 8, 2010 at 08:00 | Report abuse | Reply
  33. Emily

    Watch the documentary, the "Business of Being Born". You will see the why and how the United States has a poor pregnancy rates, maternal and newborn deaths, see the difference between "institutional" births vs "at home" births. Its very interesting. I recommend to anyone whos a parent, thinking of becoming a parent, med students, young adults, EVERYONE! It almost makes me sick to think the US is so behind on this subject.

    May 8, 2010 at 10:47 | Report abuse | Reply
  34. LonelyDad

    California has started to look into this the high US rate, so there's a little more information here:

    May 8, 2010 at 12:37 | Report abuse | Reply
  35. Maddy Oden

    The fact is that maternal mortality is VERY high in the US. It does NOT just occur to women who don't have adequate prenatal care, or who are low income. It can happen to ANY woman. My daughter and her baby died during childbirth, because of medical interventions that did NOT need to occur. African American women have a maternal mortality rate FOUR times as high as white women in the US.
    Women die in childbirth in the US due to unnecessary interventions,
    ( ie inductions and C Sections that were not needed, but done for convience of the doctor), as well as other reasons.
    It is an issue that must be dealt with.

    May 9, 2010 at 11:02 | Report abuse | Reply
  36. Season Brusch

    Peter, this issue has been extensively covered by CNN. Health coverage has a lot to do with it, but so does the rate of unnecessary cesarean sections and the health of the woman before conception.

    May 9, 2010 at 13:25 | Report abuse | Reply
  37. carolyn

    I feel there are too many unnecessry interventions. We live in this wonderful country with everything at our fingertips.....everything is quick, hurry up..we shouldnt interfere with childbirth unless there is an emergency
    My daughter age 26, passed away a few hours after giving birth to a healthy child. My daughter took care of herself, exercised, attended prenatal classes with her husband, didnt miss an OBGYN checkup. She wanted a natural birth in a hospital with her doctor monitoring in case of emergency. She was "post date". It was decided she be induced. My daughter was not in distress, the baby was not in distress. As we learned months later, she was induced with a drug {cytotec} that is not FDA approved for induction of labor. In fact there are lfe threatening risks listed on the label......my daugher died of one of those adverse affects listed on label.......Why did they induce????. She was not told of those risks!!
    Please dont just say that women that dont take care of themselves, or dont have health care, or have drug addictions etc are the mothers that die. My daughter was in perfect health, took care of herself entered a hospital happy and excited to be a mom. Wanted a natural birth. Just wanted to be Mommy. Please I implore you to take a look at these unnecessary interventions. This should not be happening!!
    Please help..

    May 9, 2010 at 19:41 | Report abuse | Reply
  38. Belle

    Hey Guys,
    I'm from Australia and I don't think it's the obesity thing because Australia is not far behind USA in obesity stats yet Australia is No. 2 on the list for best places for a Mum.
    Who knows?

    May 10, 2010 at 08:18 | Report abuse | Reply
  39. chris

    It doesn't take some CNN doctor to explain why your maternal deaths are so high...too little health care and too much meth in the great US of A. Hopefully now that you are joining the civilized world in providing health care to those that need it instead of just those that can afford it, not as many mothers will die.

    May 10, 2010 at 12:18 | Report abuse | Reply
  40. drsolo

    I wonder how many teenage girls in the top rated countries give birth? Young girls are particularily at risk of dying from pregnancy or childbirth-related causes. I bet statistics state by state would illuminate the problem. States that do everything they can to keep contraceptives out of the hands of teenagers and restrict abortion to the young and all poor women probably have the highest death rates.

    May 11, 2010 at 00:53 | Report abuse | Reply
  41. JustWontDoIt

    I have a heart condition and after reading this article...it just confirmed my decision not to have children...especially here in the US. IF i choose to do it, it will be done where people apparently know what the hell they are doing...besides i have always wanted to move to Ireland 🙂 If i get pregnant, there is no risk to the baby, but all the risk to me. Everything from having "a normal" pregnancy, to "we'll just put you on hospitalized bed rest then at 6 months get the baby out" to "you will die". I'm 25...and i know in my heart i will never have children. It is not an option for me. and you know what, the fact that the US is ranked number 28 doesn't really shock me all that much. Its not like we have a good health care system. trust me, i know...i have had to deal with this bs my entire life.

    June 16, 2010 at 19:45 | Report abuse | Reply
  42. Peter Stern

    Sweden is one of the best places to be a mom because it's one of the WORST places to be a dad:

    October 7, 2010 at 19:10 | Report abuse | Reply
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