“No mother should have to fear for her life while bringing a baby into the world.”
UNICEF Executive Director, Catherine Russell, in response to the latest World Health Organization (WHO) global estimates on Trends in maternal mortality.
It’s a simple and obvious phrase that all of us would agree on. The world has never been richer, with all the capabilities in technology and intelligence, with information transmitted across the world in a nanosecond and with the common tools to prevent maternal deaths. Yet women and girls continue to die in childbirth due to a lack of access to good-quality, affordable sexual and reproductive health services and pregnancy care.
No mother should die when giving birth to her child. This was the consensus that countries around the world agreed on during the development of the SDGs and the commitment made in SDG 3.1 – to reduce global MMR (maternal mortality ratio) to less than 70 maternal deaths per 100,000 live births by 2030.
Why are women and girls still dying in childbirth?
Latest WHO estimates show that, after 2016, the decline in the rate of maternal mortality has stalled, and women and girls continue to die at high rates globally (~223 maternal deaths per 100,000 live births). In some higher income regions – Europe and North America, and Latin America and the Caribbean – there has been an increase in maternal mortality. The results show that 70% of global maternal deaths are happening in sub-Saharan Africa, indicating that pregnant women and girls in Africa are still bearing the brunt of inefficient and ill-equipped health care systems.
In recent years, the de-prioritisation of the rights of women and girls, and severe budget cuts in both national and donor investments to strengthen maternal, sexual and reproductive health services have threatened the previous gains in reducing maternal mortality globally. At the peak of the pandemic, in 2021, the Global Financing Facility reported that for each COVID-19 death more than two women and children died due to pandemic-related disruptions to health services.
Today, a 15-year-old girl who lives in a poor community in sub-Saharan Africa is at greatest risk, with a 1 in 40 chance of dying because of childbirth. That’s 400 times higher than her peers in Australia.
In far too many countries, adolescent girls experience restricted access to sexual and reproductive health services and information. Complications from pregnancy and childbirth are still a leading cause of death among girls aged 15–19 globally. When the rights of girls are undermined and when social or cultural norms prohibit adolescents’ access to lifesaving sexual health information, services and commodities, they are at increased risk of unplanned and early pregnancy, unsafe abortions, and sexually transmitted illnesses. It is time for governments, policy-makers, parents, and medical staff to support all adolescents to access sexual and reproductive health services. In our upcoming analysis, The Adolescent Health & Nutrition Index, we have analysed the health and nutrition outcomes of adolescents across policy and financing environment in 75 low- and middle-income countries. We have found that gaps in financing have created enormous access issues, resulting in adolescent health and wellbeing being damaged.
A closer look at the data
While global trends are useful in outlining the big picture and highlighting broad areas of system failure, they can hide vast inequities in health access within regions and, at a more granular level, between members of a single community.
The significant increases in these latest estimates in maternal deaths in high-income countries like USA and Greece are a stark reminder that policy-makers must tackle the social determinants that lead to poor health access everywhere. Women and girls living in the richest countries will not be protected against maternal deaths if they are marginalised due to socio-demographic factors, such as race, poverty, sexual identity or immigrant communities. A recent analysis into maternal deaths in the USA before and after the COVID-19 pandemic reported an 18.4% increase in maternal mortality from 2019–2020, with the highest rates of death among Hispanic and non-Hispanic Black women.
All governments must strive to achieve health equity – ensuring that all people can attain the highest standard of health, particularly vulnerable groups who are most at risk of marginalisation and discrimination.
Leaders must act now
When the WHO released these estimates, they inserted a horrifying tag line: “Every two minutes, a woman dies during pregnancy or childbirth.”
Surely this should be enough of a call to action to push policy-makers and governments to invest in their health systems; to adequately equip their primary healthcare clinics, stock their medical stores with essential medicines and equipment, and train and retain their midwifes and nurses, to ensure the highest standard of health services for the population.
Since 2020, we have been confronted by the dangers of underinvestment in health care services, and the continuing gaps in maternal, adolescent and newborn heath financing. We have all experienced, to varying degrees, the tremendous impact poor health systems can have on our families, our communities and our societies. The fact that we are failing our women and girls globally during childbirth is a warning that we must accelerate our commitments to women and girls so that they can exercise their right to live healthy lives.
Governments must accept that the health of their population, particularly the safety of women and girls, is a crucial enabler of stronger economies and secure societies. They must therefore invest in their health systems.
In 2023, there will be plenty of opportunity for governments and heads of state to step up and emphasise their commitment to women and girls – and announce new commitments to invest in maternal, sexual and reproductive health. One such moment will be the Global Forum for Adolescents in October, marking the world’s largest global gathering focused on adolescent wellbeing and bringing together policy-makers, adolescent and youth advocates, and civil society to mobilise action for adolescents.
These recent estimates from WHO are a clear warning that reducing maternal deaths remains one of the most pressing global health challenges. And more importantly, that progress won between 2000 and 2015 in reducing maternal deaths will not hold without dedicated commitment from global health leaders.
8 March is International Women’s Day.
Photo: Newborn baby Samuel with his mother, Linet, at a health centre in Bungoma, Kenya (photo: Sarah Waiswa/Save the Children).
