Over 60% of maternal deaths in 2023 took place in countries and territories experiencing conflict or institutional and social fragility, according to a World Health Organization (WHO) report published on Tuesday.

“In 2023, an estimated 260,000 women died from causes related to pregnancy and childbirth. Around 160,000 of those deaths occurred in settings experiencing conflict or institutional fragility,” Jenny Cresswell, WHO sexual and reproductive health scientist, told a media briefing in Geneva on Tuesday.

“The majority of women dying in pregnancy today are not dying because we lack medical solutions. They are dying because of structural weaknesses in health systems, often rooted in conflict, crisis and instability,” Cresswell added.

The maternal mortality ratio in conflict-affected countries was 504 maternal deaths per 100,000 live births in 2023, accoding to the report.

In fragile settings, it was 368 deaths per 100,000 and countries not affected by these challenges, it was 99 per 100,000. 

The cost of disrupted services

“The overwhelming majority of these deaths can be prevented,” Cresswell stressed. “That gap is not a coincidence. It is the cost of disrupted services, damaged hospitals, health workers fleeing violence, interrupted supply chains, and women unable to reach quality care safely or quickly enough at the time that this is needed. 

“This means that women are dying from preventable maternal causes in conflict settings, such as haemorrhage or excessive bleeding relating to childbirth, hypertensive disorders such as pre-eclampsia, infections and complications relating to unsafe abortion.”

A 15-year-old girl living in a country or territory affected by conflict in 2023 had a 1 in 51 lifetime risk of eventually dying from a maternal cause, in comparison to a 1 in 593 risk for  15-year-old girl living in a country not affected by conflict or institutional and social fragility.

Around 10% of women of reproductive age lived in the 17 countries and territories classified as experiencing conflict by the World Bank, where 21% of all live births, and 55% of all maternal deaths occurred. 

The 20 countries and territories classified as experiencing institutional and social fragility were home to just 2% of all women of reproductive age, 4% of all live births and 7% of all maternal deaths.

Progress is possible

But progress is possible, as the report shows.

The MMR in Ethiopia decreased from 267 to 195 maternal deaths per 100 000 live births between 2020 and 2023.  But pregnant women in the areas affected by conflict, drought and displacement – particularly the Tigray, Amhara, Afar and Oromia regions – faced “significant challenges” to get essential maternal health services.

These included a lack of ambulances, restrictions on vehicle movements at night, and health workers fleeing from conflict-affected areas. 

In response, the WHO, United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA), with funding support from the Bill & Melinda Gates Foundation, launched the Service Delivery Innovations in Conflict-Affected Areas (SDI) project in Amhara, Oromia and Afar, in collaboration with Ethiopia’s Ministry of Health and Regional Health Bureaus.

This resulted in three ambulances and six mobile health service teams being deployed to underserved and remote communities. Twenty-four maternity waiting homes, six neonatal intensive care units and four maternity wards were renovated, and 24 midwives were trained and deployed.

“Since the SDI project began in 2022, the number of deliveries attended by skilled health workers increased from 12,790 to 17,620 in 2024,” according to the report.

“The number of women and girls receiving at least four antenatal care visits rose from 15,636 in 2022 to 23,228 in 2024”, while the number of women receiving postnatal care visits within seven days of delivery increased from 17,611 in 2022 to 21,730 in 2024”.

Off track

“The world is committed to reducing maternal mortality globally to fewer than 70 deaths per 100,000 live births by the year 2030, but at current rates, we are off track,” said Cresswell.

“We must protect maternal health in fragile settings. That means investing in primary health care, protecting health workers and facilities, ensuring emergency obstetric services remain functional during crisis,” she added. “No woman should lose her life, giving life.”

The WHO report also recommends “improving data collection on maternal and newborn mortality at the subnational level, particularly in settings where humanitarian access is restricted, can help identify and address inequities and track progress towards ending preventable maternal deaths.”

Additional reporting by Elaine Fletcher.

Image Credits: Nicolò Filippo Rosso/ WHO.