Eight Hundred Women Die Every Day During Pregnancy or Childbirth
In 2020, a woman died every two minutes from pregnancy or childbirth.

By the time you finish reading this article, at least two women will have died from complications in pregnancy or childbirth. In the next 24 hours, another 798 will lose their lives. Nearly all of these women will be from low-and lower middle-income countries, and nearly all of their deaths will have been preventable. 

These are the jarring findings of a new multi-agency UN report tracking deaths related to pregnancy and childbirth from 2000 to 2020 published on Thursday.

The report paints a vivid picture of the dangers faced by women who lack access to the basic but life-saving health services for preventing maternal deaths that most of the world has benefited from for decades. 

Yet instead of showing progress, the report reveals an alarming new development: nearly all regions of the world have witnessed an increase or stagnation in maternal deaths since 2016. 

The consequences for women’s health if this global backsliding continues, the report’s authors warned, will be severe. 

“We need to reverse the declines that we’re seeing in maternal mortality reductions,” said Dr Jenny Cresswell, lead author of the report. “This is a very important issue with very substantial inequities by country and within countries, which is unacceptable given that the majority of maternal deaths are due to preventable causes.”

In 2020, an estimated 287,000 women died of complications during pregnancy or childbirth – one every two minutes. For every woman who died, between 15 to 30 more paid for their survival with life-altering disabilities. And for every mother who does not make it past childbirth, a newborn is left at higher risk of dying as well. 

“The persistent gender norms that deprioritize the health of women and girls must be addressed,” said Dr Tedros Adhanom Ghebreyesus, WHO’s Director-General at a media briefing on Tuesday. 

“While pregnancy should be a time of immense hope and a positive experience for all women, it is tragically still a shockingly dangerous experience for millions around the world who lack access to high quality, respectful health care,” he added.

“Childbirth should be a time of life, not death.” 

A story of inequality

Maternal mortality ratio estimates by country 2020.

Maternal death rates tell a story of deep global inequalities. An astonishing 70% of global maternal deaths in 2020 — over 200,000 — occurred in sub-Saharan Africa, where girls aged 15 face a one in 40 chance of dying from pregnancy-related complications. Central and Southern Asia arrive in a distant second, accounting for 17% of the global death toll. 

Globally, nearly 95% of all maternal deaths occur in low- and lower middle-income countries. Meanwhile, 73 countries, mostly in Europe, Latin America and the Caribbean, recorded less than 20 maternal deaths in 2020. 

The sub-Saharan death rate is 136 times higher than in Australia and New Zealand, the region with the lowest maternal mortality rate documented in the report. 

Between countries on the statistical extremes, inequalities are staggering. 

In Chad, the country with the highest rate of maternal mortality, a 15-year-old girl has a one in 15 chance of dying of maternal causes in her lifetime. If that same girl lived in Belarus, the highest performing country analyzed in the report, she would be 4,000 times less likely to succumb to pregnancy related causes. 

The stark contrast between the world’s best and worst performing countries highlight deep divisions within countries and regions that get lost in the averages of global statistics. 

While regional disparities are heavily influenced by relative development levels and the impacts of prolonged conflict and climate change, national disparities run along the rural-urban divide that defines health access in developing countries, where limited health workforces and facilities are concentrated in cities due to their relative wealth and high population densities. 

Remote populations out of reach of their country’s central power grid also suffer from reduced levels of care in the facilities at their disposal due to a lack of access to electricity. Paired with overstretched health systems lacking in critical medicines and essential medical supplies, the absence of electricity to power even barebones medical setups limits doctors’ abilities to provide life-saving care during childbirth, or operate incubators if a child is successfully delivered. 

One billion people in low- and middle-income countries do not have access to health facilities with reliable electricity, and South Asia and sub-Saharan Africa – the two regions with the highest maternal death rates – also have the lowest rates of healthcare facilities with reliable electricity. 

“No mother should have to fear for her life while bringing a baby into the world,” said UNICEF Executive Director Cathering Russell. “Equity in healthcare gives every mother, no matter who they are or where they are, a fair chance at a safe delivery and a healthy future with their family.” 

Progress is possible, but the world is backsliding 

Global reductions in maternal mortality rate by five-year time period, 2000-2020.

The 287,000 maternal deaths seen in 2020 is more than a third lower than the 446,000 documented at the turn of the millennium. From 2020 to 2015, all global regions achieved significant reductions in maternal mortality. 

But since 2016, the year the UN’s Sustainable Development Goals (SDGs) came into effect, this era of progress has flatlined.

The SDG target for maternal mortality is to reduce deaths to 70 per 100,000 live births by 2030. The report found that for the world to reach this goal, an unprecedented reduction of 11.6% per year will be needed from 2021 to 2030. 

From 2000 to 2020, the average annual drop in maternal mortality was just 2.1% – a fifth of the rate needed to hit the SDG. 

Based on available data, the optimistic scenario outlined in the report projects the world will miss the SDG by more than double. The business-as-usual scenario, meanwhile, has the world arriving at a rate over three times the SDG target. 

Africa faces an even taller task: the continent needs to reduce maternal deaths by a staggering 86% to reach the rate set out in the SDG target. 

Australia and New Zealand, and Central and South Asia were the only two regions to make significant progress since 2016, reducing maternal mortality by 34.6% and 15.7% respectively. 

Half of global pregnancies are unplanned

Distributions of contraceptive users by method and region, 2019. / UNFPA

Nearly half of all pregnancies around the world, totalling 121 million annually, are unintended. According to the UN Population Fund (UNFPA), an estimated 257 million women wishing to avoid pregnancy lack access to safe, modern family planning methods like contraception and abortion.

In a report published in March 2022, UNFPA found that in 47 countries, about 40% of sexually active women were not using any contraceptive methods to avoid pregnancy, while nearly a quarter of all women are not able to say no to sex. 

“For the women affected, the most life-altering reproductive choice – whether or not to become pregnant – is no choice at all,” UNFPA Executive Director Dr Natalia Kanem said. “The staggering number of unintended pregnancies represents a global failure to uphold women and girls’ basic human rights.”

At a press conference with reporters on Tuesday, WHO officials said the ability to make autonomous decisions regarding reproductive health, including the choice of having children and the timing of childbirth, is crucial for women to plan and space their pregnancies and safeguard their well-being. 

A lack of access to the necessary care and medical resources leads many women to turn to unsafe abortions, which account for 45% of all abortions performed every year. These hospitalize about 7 million women a year globally and cause 5 to 13 percent of all maternal deaths – one of its leading causes.

Pregnant women from marginalized communities with limited access to essential maternity care are at increased risk due to inequalities related to income, education, race or ethnicity, the report added.

Nearly a third of women do not even have half of the recommended eight antenatal checks during their pregnancy, or receive any postnatal care. 

“We have the tools, knowledge and resources to end preventable maternal deaths,” Kanem said. “What we need now is the political will.”

Crisis and instability drive maternal deaths 

When disaster strikes, contraception and maternal health are often treated as secondary concerns.

Women and children are the first to suffer security and health consequences from war, conflict and instability. Amid the chaos, maternal health services are no longer considered essential, with dire consequences for women living in conflict zones. 

In the world’s nine most unstable countries on the Fragile States Index – Chad, Yemen, South Sudan, Somalia, Syria, Democratic Republic of Congo, Central African Republic, and Afghanistan – women die from pregnancy or childbirth at a rate more than double the world average. 

“It is telling and discouraging that the five countries with the highest maternal mortality (Afghanistan, Central African Republic, Chad, Somalia, and South Sudan) are all experiencing or recovering from conflict,” WHO said. 

This has knock on effects on the health outcomes of their potential children, too. Of the 54 countries on track to miss the SDG for child mortality, half are considered fragile or in conflict. 

Humanitarian crises push contraception down the priority list due to the increased urgency of finding food, shelter, safety, water, and other life or death necessities made scarce in times of crisis. 

International aid also prioritizes these essentials, meaning maternal health assistance is often an afterthought. Experts say changing this paradigm could save thousands of lives. 

“Delivery doesn’t wait. Whether it’s an earthquake or whether it’s COVID,” said Dr Anshu Banerjee, Assistant Director General for Universal Health Coverage at WHO. “[Maternal health services] need to be part of the core package for any intervention in a humanitarian setting.”

If the world continues on its current trajectory, an estimated one million women will die preventable deaths by 2030.

Image Credits: UN, UN, UNFPA, UNDP.

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