Maternal mortality is unacceptably high. About 295 000 women died during and following pregnancy and childbirth in 2017. The vast majority of these deaths (94%) occurred in low-resource settings, and most could have been prevented. (1)

Sub-Saharan Africa and Southern Asia accounted for approximately 86% (254 000) of the estimated global maternal deaths in 2017. Sub-Saharan Africa alone accounted for roughly two-thirds (196 000) of maternal deaths, while Southern Asia accounted for nearly one-fifth (58 000). 

At the same time, between 2000 and 2017, Southern Asia achieved the greatest overall reduction in MMR: a decline of nearly 60% (from an MMR of 384 down to 157). Despite its very high MMR in 2017, sub-Saharan Africa as a sub-region also achieved a substantial reduction in MMR of nearly 40% since 2000. Additionally, four other sub-regions roughly halved their MMRs during this period: Central Asia, Eastern Asia, Europe and Northern Africa. Overall, the maternal mortality ratio (MMR) in less-developed countries declined by just under 50%.  

Where do maternal deaths occur?

The high number of maternal deaths in some areas of the world reflects inequalities in access to quality health services and highlights the gap between rich and poor. The MMR in low income countries in 2017 is 462 per 100 000 live births versus 11 per 100 000 live births in high income countries. 

In 2017, according to the Fragile States Index, 15 countries were considered to be “very high alert” or “high alert” being a fragile state (South Sudan, Somalia, Central African Republic, Yemen, Syria, Sudan, the Democratic Republic of the Congo, Chad, Afghanistan, Iraq, Haiti, Guinea, Zimbabwe, Nigeria and Ethiopia), and these 15 countries had MMRs in 2017 ranging from 31 (Syria) to 1150 (South Sudan).

The risk of maternal mortality is highest for adolescent girls under 15 years old and complications in pregnancy and childbirth are higher among adolescent girls age 10-19 (compared to women aged 20-24) (2,3).

Women in less developed countries have, on average, many more pregnancies than women in developed countries, and their lifetime risk of death due to pregnancy is higher. A woman’s lifetime risk of maternal death is the probability that a 15 year old woman will eventually die from a maternal cause. In high income countries, this is 1 in 5400, versus 1 in 45 in low income countries. 

Why do women die?

Women die as a result of complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy and most are preventable or treatable. Other complications may exist before pregnancy but are worsened during pregnancy, especially if not managed as part of the woman’s care. The major complications that account for nearly 75% of all maternal deaths are (4):

• severe bleeding (mostly bleeding after childbirth)
• infections (usually after childbirth)
• high blood pressure during pregnancy (pre-eclampsia and eclampsia)
• complications from delivery
• unsafe abortion.

The remainder are caused by or associated with infections such as malaria or related to chronic conditions like cardiac diseases or diabetes. 

[1] Fragile States Index is an assessment of 178 countries based on 12 cohesion, economic, social and political indicators, resulting in a score that indicates their susceptibility to instability. Further information about indicators and methodology is available at: https://fragilestatesindex.org/

How can women’s lives be saved?

Most maternal deaths are preventable, as the health-care solutions to prevent or manage complications are well known. All women need access to high quality care in pregnancy, and during and after childbirth. Maternal health and newborn health are closely linked. It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death for the mother as well as for the baby. 

Severe bleeding after birth can kill a healthy woman within hours if she is unattended. Injecting oxytocics immediately after childbirth effectively reduces the risk of bleeding.

Infection after childbirth can be eliminated if good hygiene is practiced and if early signs of infection are recognized and treated in a timely manner.

Pre-eclampsia should be detected and appropriately managed before the onset of convulsions (eclampsia) and other life-threatening complications. Administering drugs such as magnesium sulfate for pre-eclampsia can lower a woman’s risk of developing eclampsia.

To avoid maternal deaths, it is also vital to prevent unwanted pregnancies. All women, including adolescents, need access to contraception, safe abortion services to the full extent of the law, and quality post-abortion care.

Why do women not get the care they need?

Poor women in remote areas are the least likely to receive adequate health care. This is especially true for regions with low numbers of skilled health workers, such as sub-Saharan Africa and South Asia. 

The latest available data suggest that in most high income and upper middle income countries, more than 90% of all births benefit from the presence of a trained midwife, doctor or nurse. However, fewer than half of all births in several low income and lower-middle-income countries are assisted by such skilled health personnel (5)

The main factors that prevent women from receiving or seeking care during pregnancy and childbirth are:

• poverty
• distance to facilities
• lack of information
• inadequate and poor quality services
• cultural beliefs and practices.

To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at both health system and societal levels.

The Sustainable Development Goals and Maternal Mortality

In the context of the Sustainable Development Goals (SDG), countries have united behind a new target to accelerate the decline of maternal mortality by 2030. SDG 3 includes an ambitious target: “reducing the global MMR to less than 70 per 100 000 births, with no country having a maternal mortality rate of more than twice the global average”. 

WHO response

Improving maternal health is one of WHO’s key priorities. WHO works to contribute to the reduction of maternal mortality by increasing research evidence, providing evidence-based clinical and programmatic guidance, setting global standards, and providing technical support to Member States on developing and implementing effective policy and programmes.

As defined in the Ending Preventable Maternal Mortality Strategy (6), WHO is working with partners in supporting countries towards:

• addressing inequalities in access to and quality of reproductive, maternal, and newborn health care services;
• ensuring universal health coverage for comprehensive reproductive, maternal, and newborn health care;
• addressing all causes of maternal mortality, reproductive and maternal morbidities, and related disabilities; 
• strengthening health systems to collect high quality data in order to respond to the needs and priorities of women and girls; and
• ensuring accountability in order to improve quality of care and equity.

(1) Trends in maternal mortality: 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2019.  

(2) Ganchimeg T, Ota E, Morisaki N, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG 2014;121 Suppl 1:40–8.

(3) Althabe F, Moore JL, Gibbons L, et al. Adverse maternal and perinatal outcomes in adolescent pregnancies: The Global Network’s Maternal Newborn Health Registry study. Reprod Health 2015;12 Suppl 2:S8.

(4) Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels JD, et al. Global Causes of Maternal Death: A WHO Systematic Analysis. Lancet Global Health. 2014;2(6): e323-e333. 

(5) World Health Organization and United Nations Children’s Fund. WHO/UNICEF joint database on SDG 3.1.2 Skilled Attendance at Birth. Available at: https://unstats.un.org/sdgs/indicators/database/

(6)  Strategies towards ending preventable maternal mortality (‎EPMM)‎.Geneva: World Health Organization; 2015.