The progress the world has made in reducing maternal mortality has stalled in recent years, with some regions — including Europe and Northern America — backsliding since 2015, according to a new report from United Nations agencies.
The report estimated that there were 287,000 maternal deaths globally in 2020, a slight decrease compared to an estimated 309,000 maternal deaths in 2016. The rate of 223 maternal deaths per 100,000 live births in 2020 meant that, on average, someone died from pregnancy- or childbirth-related issues every two minutes. Officials stressed that most of these deaths are preventable or treatable with access to quality care.
The stagnation means the globe is falling increasingly behind the U.N.’s 2030 goal of lowering maternal deaths to 70 per 100,000 live births, World Health Organization officials said as they released the report. More than 1 million additional maternal deaths will occur by 2030 if the current trends continue.
“The data are a wake-up call for us, to take action to avoid future deaths,” said Anshu Banerjee, a WHO assistant director-general.
Overall, the global rate of maternal deaths fell an average of 2.7% every year between 2000 and 2015 before flattening over the last five years. But some regions experienced rising maternal mortality rates from 2016 to 2020, with a 17% increase in Europe and Northern America and a 15% increase in Latin America and the Caribbean. WHO officials noted that those regions had comparatively low absolute maternal mortality numbers at baseline.
The new report includes data that go through 2020. Officials said the Covid-19 pandemic contributed to the lack of progress in reducing deaths, but that the stall started in at least 2016, and even earlier in some countries. Data from 2021 will help reveal the true impact of Covid-19, they said.
Not only did the pandemic disrupt care, Covid-19 infections increase the risk of pregnancy complications, the report noted.
The reasons for an individual country’s progress or lack thereof are complex and can vary, with factors including a lack of investment in primary and maternal care as well as shortages of health workers and medical supplies. But broadly, maternal mortality rates reflect whether people have access to competent, respectful care, especially in the 24 hours around birth, when most maternal deaths occur, WHO officials said at a press briefing.
“Maternal deaths increase when women have less access to quality, timely services, particularly around the time of delivery,” said Jenny Cresswell, an epidemiologist at WHO and author of the report. “Anything which creates barriers to that — either for the whole population or for subgroups within a population — can lead to increasing maternal mortality rates.”
The report documented some regional progress even amid the global stalling. Maternal mortality rates in Australia and New Zealand dropped 35% from 2016 to 2020, while the rate in Central and Southern Asia fell 16% during that time period.
Overall, maternal deaths were highest in the poorest parts of the world, where they are sometimes exacerbated by conflict and disasters. Sub-Saharan Africa continues to have the highest maternal mortality rate of any region, accounting for about 70% of all maternal deaths worldwide. It’s the only region with a maternal mortality rate that’s classified as “very high” — an estimated 545 deaths per 100,000 live births. A 15-year-old girl in Chad in 2020 has a 1 in 15 chance of dying from a maternal cause, 4,000 times the risk in Belarus.
WHO officials added that countries have reported their own domestic inequities, with disparities in maternal mortality based on health insurance access and cost of care, along racial and ethnic lines, and between cities and rural areas.
Leading causes of maternal mortality include severe bleeding, high blood pressure, infections, and other health conditions that pregnancy can aggravate, including HIV/AIDS and malaria. Another cause the report cited: complications from unsafe abortions.
At the press briefing, WHO officials stressed that women deserve autonomy over their sexual and reproductive health. Nearly half of pregnancies are unplanned, underscoring how an estimated 270 million women lack modern family planning methods.
“The ability for women to choose if, when, and how many children they will have is a fundamental right,” said Lale Say, WHO’s unit head for integration in health systems.