Geneva, Feb 19: Nearly two-thirds of global maternal deaths occur in countries affected by conflict or fragility, according to a new analysis by the World Health Organization and its research arm, the Human Reproduction Programme, highlighting widening inequality in maternal health outcomes.
The report estimates that in 2023, around 260,000 women died due to pregnancy- or childbirth-related complications — equivalent to one death every two minutes. Of these, about 160,000 deaths occurred in fragile and conflict-affected settings, which account for just one in 10 live births globally but six in 10 maternal deaths.
The global maternal mortality ratio (MMR) stands at 197 deaths per 100,000 live births, significantly above the Sustainable Development Goal target of fewer than 70 by 2030. While maternal deaths declined 40 per cent between 2000 and 2023, progress has largely stagnated since 2016, the report noted.
Countries experiencing conflict recorded an estimated MMR of 504 deaths per 100,000 live births, compared with 368 in institutionally and socially fragile settings. In relatively stable countries, the ratio was 99.
The lifetime risk also varies sharply. A 15-year-old girl living in a conflict-affected country in 2023 faced a one in 51 lifetime risk of dying from a maternal cause, compared with one in 79 in institutionally fragile countries and one in 593 in stable settings.
“Nearly two-thirds of global maternal deaths occur in countries affected by conflict or fragility,” the WHO said, warning that humanitarian funding cuts, facility closures, supply chain disruptions and workforce displacement are worsening outcomes.
“It will be critical to strengthen the underlying health and reproductive rights of women and girls,” WHO Director-General Tedros Adhanom Ghebreyesus said in response to the findings.
The agency’s broader analysis identified severe haemorrhage and hypertensive disorders, including preeclampsia, as leading causes of maternal mortality. In 2020, haemorrhage accounted for nearly 80,000 deaths, while hypertensive disorders contributed to about 50,000. Sepsis remains another significant but preventable cause.
A trial led by WHO, HRP and the University of Liverpool found that structured infection-prevention protocols under the APT-Sepsis programme reduced infection-related maternal mortality and severe morbidity by 32 per cent across 59 hospitals in Malawi and Uganda.
Describing the findings as evidence of what can be achieved “when science, policy, and frontline care come together,” WHO Assistant Director-General Jeremy Farrar underscored the need for resilient systems.
The report noted that one-third of women in lower-income countries do not receive essential postnatal checkups in the first days after delivery. WHO estimates that every US$1 invested in maternal and newborn care in low- and middle-income countries can generate returns of US$9 to US$20 through improved health and productivity.
In Latin America and the Caribbean, about 8,400 women die annually due to pregnancy-related causes. The regional MMR stood at 88 per 100,000 live births in 2020, above the 2030 target of 30, according to the Pan American Health Organization.
In 2024, PAHO and MSD launched a US$1 million initiative in Honduras and Peru to improve responses to obstetric emergencies and unintended pregnancies.
In Mexico, 534 maternal deaths were recorded in 2024 and 88 in early 2025, with women aged 45–49 facing the highest mortality ratio of 164.6 per 100,000 live births. Indigenous women experienced lower effective maternal health coverage at 18.3 per cent compared with 25.3 per cent for non-indigenous women, reflecting persistent inequality.
Cesarean deliveries in Mexico increased from 45 per cent in 2010 to 55 per cent in 2023, reaching as high as 80 to 90 per cent in some private facilities. Despite higher surgical delivery rates, maternal and neonatal mortality have not declined proportionally.
Authorities have introduced regulatory reforms, including NOM-020-SSA-2025 to integrate professional and traditional midwives into the national health system, and updated guidelines under PROY-NOM-020-SSA-2024 emphasising evidence-based protocols and informed consent.
The WHO said maternal mortality is “not only a clinical issue but a systemic one,” driven by conflict, funding volatility, discrimination, workforce shortages and weak health infrastructure. Without sustained investment and targeted reforms, the agency warned, “fragile progress could erode,” particularly in high-risk settings.
