Each day, almost 800 women die from preventable causes related to pregnancy and childbirth. A maternal death occurs every two minutes. Maternal mortality is defined as the death of a woman from complications of pregnancy or childbirth that occur during the pregnancy or within 6 weeks after the pregnancy ends.*

Maternal mortality remains a major global health crisis, despite global calls to attention. The staggering reality is that most maternal deaths are preventable and are caused by massive health inequalities which exist within and between countries on a global scale.

These inequalities are profound. Almost 95% of all maternal deaths occur in low- and middle-income countries—with the greatest risk existing across Sub-Saharan Africa, which accounts for 70% of all maternal deaths. The current global rate of maternal deaths (223 maternal deaths per 100,000 live births) also remains far above the 2030 United Nations Sustainable Development Goal, which aims to reduce this figure to less than 70 maternal deaths per 100,000 live births.

In a new policy brief, Drivers of Global Maternal Mortality, The Wilson Center’s Maternal Health Initiative examines the current state of maternal deaths around the world—as well as their key causes. We focus on global trends that create a negative impact on maternal health and mortality rates, and conclude by offering recommendations to address underlying systemic causes and social determinants of maternal deaths, and what is necessary to lower global maternal mortality rates.

Drivers of Global Maternal … by The Wilson Center

Nearly 75% of all maternal deaths stem from major complications which include severe bleeding (mostly bleeding after childbirth); infections (usually after childbirth); high blood pressure during pregnancy (pre-eclampsia and eclampsia); complications from delivery; and unsafe abortion. Pre-existing conditions such as chronic anemia, chronic hypertension, and diabetes are also a growing concern across the maternal health space.

While the biomedical contributors to maternal death are significant, focusing solely on interventions to address them ultimately ignores the most likely driver of stagnating maternal death rates. Social determinants of health—such as poverty, education level, and access to healthcare—play a large, yet overlooked, role in the severity of maternal mortality causes and trends. Women in low-income countries are at particular risk for maternal mortality. The lifetime risk of maternal death is 1 in 5300 in high-income countries, as opposed to 1 in 49 in low-income nations. On the individual and household level, research shows that low family income and poverty are associated with higher maternal mortality in low-income countries.

Racial disparities in maternal mortality also exist in a global context. Afrodescendent women and girls are more likely to die during childbirth than almost every other racial and ethnic group in the Americas. Adolescents face increased maternal mortality risks as well. Adolescent mothers have high rates of unsafe abortion—an estimated 3.9 million out of 5.6 million abortions that occur yearly for girls aged 15 to 19 are unsafe. Low education for women can be a strong predictor of maternal death. Improving education for women and girls also can delay marriage and childbearing, which can lead to better health outcomes for pregnant women.

Ultimately, unequal gender norms across the globe also play a powerful role. Countries with high gender inequality are associated with higher maternal mortality rates compared to countries with low gender inequality. Gender-based violence is often a significant barrier for pregnant people accessing quality health services. Gender inequity also amplifies other social determinants of maternal health. Understanding the impacts of social determinants of health and intersectional issues is key to improving maternal health outcomes.

Maternal mortality rates have shifted downward over the last few decades, largely due to increased access to contraceptives and family planning, skilled birth attendants, and emergency obstetric care. Yet progress in reducing maternal deaths has stagnated in recent years. The US foreign policy also has demonstrated historical impacts on global maternal mortality rates.

Urgent action is needed to address the stagnation in progress towards ending preventable maternal deaths. We present the following recommendations to improve maternal health outcomes globally:

1. Strengthen health systems and bolster innovations to ensure access to quality maternal health care.
2. Prioritize social determinants of maternal health through research, investment, and policy action.
3. Integrate maternal health into guidance related to humanitarian and fragile settings.
4. Ensure that maternal health services are included in climate change readiness.
5. Create evidence on the harmful effects of restrictive policies on maternal health outcomes.
6. Increase global investments in maternal health services globally.