For years, the primary approach to improving global maternal health was additive – to increase capacity to address shortfalls in clinics, doctors, supplies, information, and skilled care. Today, however, some women are experiencing issues related to the opposite problem: too much.

“Midwives play a vital role in the health care of mothers and babies,” said Samara Ferrara, a midwife from Mexico, at the Wilson Center on February 27. But in many parts of the world they face a confluence of stressors that make working conditions miserable: low and irregular pay; harassment and disrespect from both patients and doctors; and little supplies, training, or say in the policy dialogue about maternal health.

Urbanization is changing the face of poverty and marginalization, and the maternal and newborn health field needs to change too, said a panel of experts at the Wilson Center on January 24.

Where violent conflict displaces people and disrupts societies, maternal and child health suffers, and such instability is widespread today. According to the UN Refugee Agency, there are 65.3 million forcibly displaced people, 21.3 million refugees, and 10 million stateless people over the world. In addition, more than 65 million people who are not displaced are affected by conflict.

Between 1990 and 2015, there was an incredible 44 percent decrease in global maternal mortality rates. But these impressive gains still fell short of the Millennium Development Goal of reducing the global maternal mortality ratio by three quarters.

Since the end of World War II, the number of wars between states has declined significantly, but the number of intrastate civil conflicts – as seen in Syria and Afghanistan – has increased.