Maternal

Maternal mortality is unacceptably high. About 287 000 women died during and following pregnancy and childbirth in 2020. Almost 95% of all maternal deaths occurred in low and lower middle-income countries in 2020, and most could have been prevented.

Maternal

Sustainable Development Goal (SDG) regions and sub-regions are used here. Sub-Saharan Africa and Southern Asia accounted for around 87% (253 000) of the estimated global maternal deaths in 2020. Sub-Saharan Africa alone accounted for around 70% of maternal deaths (202 000), while Southern Asia accounted for around 16% (47 000).

At the same time, between 2000 and 2020, Eastern Europe and Southern Asia achieved the greatest overall reduction in maternal mortality ratio (MMR): a decline of 70% (from an MMR of 38 to 11) and 67% (from an MMR of 408 down to 134), respectively. Despite its very high MMR in 2020, Sub-Saharan Africa also achieved a substantial reduction in MMR of 33% between 2000 and 2020. Four SDG sub-regions roughly halved their MMRs during this period: Eastern Africa, Central Asia, Eastern Asia, and Northern Africa and Western Europe reduced their MMR by around one third. Overall, the maternal mortality ratio (MMR) in least-developed countries* declined by just under 50%. In land locked developing countries the MMR decreased by 50% (from 729 to 368). In small island developing countries the MMR declined by 19% (from 254 to 206).

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 2020 was 430 per 100 000 live births versus 12 per 100 000 live births in high income countries.

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

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 women as well as for the newborn.

It is clear from the data that the stagnation in maternal mortality reductions pre-dates the start of the COVID-19 pandemic in 2020. The COVID-19 pandemic may have contributed to the lack of progress but does not represent the full explanation.

The level of maternal mortality during the COVID-19 pandemic may have been impacted by two mechanisms: deaths where the woman died due to the interaction between her pregnant state and COVID-19 (known as an indirect obstetric deaths), or deaths where pregnancy complications were not prevented or managed due to disruption of health services.

The global MMR in 2020 was 223 per 100 000 live births; achieving a global MMR below 70 by the year 2030 will require an annual rate of reduction of 11.6%, a rate that has rarely been achieved at the national level. However, scientific and medical knowledge are available to prevent most maternal deaths. With 10 years of SDGs remaining, now is the time to intensify coordinated efforts, and to mobilize and reinvigorate global, regional, national, and community-level commitments to end preventable maternal mortality.

As defined in the Strategies toward ending preventable maternal mortality (EPMM) and Ending preventable maternal mortality: a renewed focus for improving maternal and newborn health and well-being, WHO is working with partners in supporting countries towards:

The most common direct causes of maternal injury and death are excessive blood loss, infection, high blood pressure, unsafe abortion, and obstructed labour, as well as indirect causes such as anemia, malaria, and heart disease.

Ending preventable maternal death must remain at the top of the global agenda. At the same time, simply surviving pregnancy and childbirth can never be the marker of successful maternal health care. It is critical to expand efforts reducing maternal injury and disability to promote health and well-being.

The Sustainable Development Goals (SDGs) offers an opportunity for the international community to work together and accelerate progress to improve maternal health for all women, in all countries, under all circumstances.

SDG targets for maternal health include 3.1, aiming for an average global ratio of less than 70 deaths per 100 000 births by 2030, and 3.8, calling for the achievement of universal health coverage. These cannot be achieved without reproductive, maternal, newborn and child health coverage for all.

We currently have several funding opportunities open aimed improving maternal health outcomes and reducing disparities. These include the Alliance for Innovation on Maternal Health program and the Integrated Maternal Health Services investment.

The surge in substance use-related illness and death in recent years particularly affects pregnant women. In fact, substance use is now a leading cause of maternal death. Pregnant and postpartum women who misuse substances are at high risk for poor maternal outcomes, including preterm labor and complications related to delivery; problems frequently exacerbated by malnourishment, interpersonal violence, and other health-related social needs. Infants exposed to opioids before birth also face negative outcomes, with a higher risk of being born preterm, having a low birth weight, and experiencing the effects of neonatal abstinence syndrome (NAS). In addition, Medicaid pays the largest portion of hospital charges for maternal substance use, as well as a majority of the $1.5 billion annual cost of NAS. Despite the significant and costly burden of maternal opioid misuse, numerous barriers impede the delivery of well-coordinated, high-quality care to pregnant and postpartum women with OUD, including:

Maternal Mortality Review Committee data included in this report were provided by Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Kansas, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, North Carolina, Nebraska, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Virginia, Washington, West Virginia, Wisconsin, and Wyoming Departments of Health or agencies responsible for maternal mortality review. Any published findings and conclusions are those of the authors and do not necessarily represent the official position of these departments of health or agencies responsible for maternal mortality review. This project was supported, in part, by an appointment to the Research Participation Program at the Centers for Disease Control and Prevention, administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the US Department of Energy and the Centers for Disease Control and Prevention. We are also grateful to the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality program at the Centers for Disease Control and Prevention and to the CDC Foundation. We acknowledge Antoinette Nguyen, Deborah Burch, and Shanna Cox for their contributions of clinical and scientific expertise to this brief. 041b061a72