April 11 is the International Day for Maternal Health and Rights. Globally, 800 women die each day from preventable causes due to pregnancy and childbirth. Improving maternal health outcomes and preventing maternal deaths requires a human rights-based approach that protects a person’s right to survive childbirth, to access high-quality health care, to government accountability, to equity and non-discrimination when accessing care, and to family planning and contraception. Enshrining these rights for all pregnant people is key to meaningful progress towards the prevention of maternal deaths globally.

The Right to Survive Childbirth

Each year, roughly 287,000 women die due to pregnancy related causes across the globe, with the vast majority of these deaths occurring in low- and middle-income countries. The COVID-19 pandemic, rising poverty levels, increases in the number of conflicts and humanitarian crises, as well as the growing impacts of climate change have each contributed to poor maternal health outcomes and have significantly strained health systems globally.

The leading causes of maternal death – hemorrhage, infection, pre-eclampsia, and complications from delivery – are mostly preventable and can be attributed to shortfalls in health care systems . Access to quality care and cost-effective interventions to prevent maternal mortality and morbidity, particularly in low resource settings, are important steps toward improved health outcomes. One recent innovative breakthrough, E-MOTIVE aims to reduce deaths due to postpartum hemorrhage using a low-cost collection “drape” in addition to WHO-recommended treatments and has been shown to dramatically improve outcomes. Increased investment in similar solutions for other contributors to maternal death is needed to reduce these preventable deaths.

The Right to High Quality Care

Promoting accessible high-quality health care is a significant component of preventing maternal death. Poorly equipped health systems can contribute to instances of disrespect and abuse during pregnancy. Respectful Maternity Care (RMC) is a core human right for pregnant people, though knowledge of RMC standards for health care providers is low globally. Women may also be unaware of their right to information, informed consent, and respectful care. Providing comprehensive education on RMC to both pregnant people and maternal health providers is critical to preventing disrespect and abuse during pregnancy and delivery. Providers of maternal health services, such as midwives, can also play an important role in promoting RMC in maternity care.

Health systems must also prioritize the provision of maternal health care alongside primary health care, especially in times of crisis. In humanitarian and conflict settings, healthcare systems are often disrupted, limiting access to essential health services, including maternal health services. Ensuring that high-quality obstetric, prenatal, and postnatal care is available alongside all other health care services is critical to protecting the health and well-being of pregnant people.

The Right to Equity and Non-Discrimination

Gender inequality is also significantly associated with maternal mortality. Prior research suggests that positive attitudes towards women’s decision making capacity and gender equality are associated with positive maternal health outcomes, indicating the importance of a rights-based approach to maternal health. Investment in primary and higher education, expanding opportunities for paid employment, increasing leadership roles, reducing gender-based violence, and ending child marriage are all actions to improve gender equality and subsequently maternal mortality globally.

Research from the United Nations Population Fund (UNFPA) points to racism as a driver of disparities in maternal health outcomes for women and girls of African descent globally. In the United States, Black women are 3-4 times more likely to die in childbirth than white women. While experts and practitioners confirm that this disparity persists worldwide, few countries outside of the United States collect race-disaggregated maternal health data, leading to a gap in understanding the true scope of this inequity. Pregnant people belonging to racial and ethnic minority groups globally report discrimination within the health system, systemic biases based on misinformation, and structural barriers to receiving high-quality care. In addition, exposure to conflict and gender-based violence contribute to the unique barriers pregnant people face in accessing care. Further research on the drivers of disparities for pregnant people must also adopt a rights-based approach to ensure access to quality health care services free of discrimination.

The Right to Government Accountability

Governments have a responsibility to ensure the health and well-being of their country’s residents, including their maternal health. Research shows that country-led good governance – measured by effectiveness, regulatory capacity, rule of law, control of corruption, accountability, and political stability – is associated with low maternal mortality rates. This relationship was found to go beyond countries’ wealth status, underscoring the importance of strong government accountability in improving maternal health.

Governments must also be held responsible for investment in maternal health. In 2023, government leaders and philanthropic organizations committed to investing $445 million USD to strengthen primary health care to improve the health of women and children. Increased country-level investment in health systems strengthening, as well as improved research and tracking of maternal health outcomes, are necessary for nations to play their part in preventing maternal mortality. 

The Right to Family Planning and Contraception

Across low- and middle-income countries, approximately 218 million women have an unmet need for modern contraception – that is, they are sexually active and report either not wanting more children or wanting to delay childbirth, but are not using any method of contraception. This disparity contributes to maternal mortality and morbidity, as access to contraception and family planning can reduce unintended pregnancies. Barriers to this access include a limited choice of methods, limited access to services, fear of side effects, or cultural oppositions to contraception. Increasing access to contraception and family planning promotes the right to education and information, and the right to decide the number and spacing of children.