• Analysis also reveals 28 million women will give birth outside of a health facility.

• New Save the Children briefing reveals how growing conflicts, climate-disasters and a renewed push back against reproductive care and education hits vital maternal healthcare and threaten lives.

• Save the Children runs midwifery services, funds delivery wards and distributes birth kits to women all around the world.

2 MAY 2024 – The state of pregnancy and childbirth is a global ‘silent emergency’ as 24 million mothers will give birth without a doctor, midwife or nurse in 2024, Save the Children said.

Amidst growing conflicts, climate-disasters and a renewed push-back against reproductive care and education, the children’s charity says mothers and children are more vulnerable now than ever.

Save the Children’s briefing, Silent Emergency: Women Dying to Give Life, reveals how these interlocking crises are turning more of the world’s countries into dangerous frontlines for pregnant women and putting the brakes on progress towards a world where childbirth is no longer a deadly threat.

The presence of a doctor, nurse or midwife [1] during childbirth means more mothers get to hold their newborn babies safely in their arms. Yet the charity further estimates that this year 28 million women will give birth outside of a health facility [3]. Across the world, a woman dies from complications due to pregnancy or childbirth every two minutes[2].

Action on maternal health worldwide was advancing a decade ago. But at the global level, almost all the progress achieved in maternal mortality had occurred by 2015 and has stagnated since then [4] and progress to achieve the UN goal of 70 deaths per 100,000 births globally by 2030 is stalling. Maternal mortality rates have plateaued in many countries.

The briefing explores how during times of conflict, climate-related disasters and humanitarian emergencies, the availability of maternal healthcare diminishes significantly.

With global conflict increasing year on year [5], the analysis found that pregnant mothers in warzones are three times more likely to give birth without a doctor, midwife or nurse. Analysis also found almost half of births (44%) in conflict zones take place outside a health facility compared to 15% of births elsewhere.

Nowhere has the devastating impact of conflict been more evident than in Gaza, where six months of constant bombardment, siege and obstruction of aid deliveries have annihilated the health system.  There were at least 435 attacks on health facilities or personnel between 7 October 2023 and early April 2024 – equivalent to 73 attacks per month of war [6].

Save the Children’s Emergency Health Unit has established maternal health services in Al Mawasi to provide emergency obstetric care for women to deliver safely, supported by skilled midwives who can see 100 patients a day, including the provision of antenatal care and postnatal care services.

Elsewhere, climate change is increasing the frequency of extreme heat and wildfires, which are associated with heightened risks of preterm birth, stillbirths and pregnancy complications.

Today’s briefing calls for renewed action from governments to protect the lives of women and children through strong primary health care, comprehensive sexual and reproductive services and education, underpinned by effective, sustainable financing.

Tara Brace-John, Head of Health: Global Policy, Advocacy & Research at Save the Children UK, said:

“No woman should face childbirth alone and every woman deserves the right to give birth safely and with dignity. Women living in even the most remote and dangerous areas of the world should have access to medical care, and equipment, as well as the right to access reproductive services and education.

“A mother holding her newborn baby safely in her arms for the very first time is the most precious moment there is. We need to act now to ensure mothers do not lose their children, and children do not grow up without mothers. Lasting change starts with women everywhere being able to expect better.”

Somalia is grappling with the devastating impact of the climate crisis and is listed in the 10 worst conflict-affected countries for children in 2022 [7].

Across the country, only 31.9% of women give birth with a doctor, midwife or nurse present - the lowest rate of skilled birth attendance in the world [8]. Supported by the Damal Caafimaad Project [9], Save the Children reopened the Beledweyne hospital in October 2023, which had not been fully operational for over a decade. Contributing to reducing the number of mothers and babies dying, the hospital’s maternal health services - including antenatal care, postnatal care, and carrying out caesarean sections - has helped over 15,000 patients.

Rahma*, 32, said her previous home births were traumatic. “When I gave birth to my last child at home, it was tough,” the mother-of-eight explained. “I couldn't find a professional nurse and I had a lot of bleeding. It was a dangerous situation - I almost died.”

Rahma was able to have her next child in the hospital under the care of the midwifery team.  “The nurses checked my blood pressure, temperature, and the baby's heart rate right away,” she said. “I was having strong contractions and asked for something for the pain. They gave me painkillers, which helped a lot.

“After a few hours of hard labour, I gave birth to a healthy baby boy, called Ahmed*. They took good care of both of us right after the birth and before I left the hospital, I talked to a nurse about breastfeeding and the support I could get.”

Save the Children says the UK has a key role to play in increasing investments in primary healthcare and to build strong resilient health systems which have the capacity to ensure that women around the world will be able to deliver babies without risking their lives.  Amidst the backlash against reproductive rights, the UK must continue to champion and stand up for the rights of women and girls to access the reproductive care, products and education they need.

ENDS

*Names have been changed

NOTES

[1] A skilled birth attendant (SBA) is an accredited health professional - such as a midwife, doctor or nurse - who has been educated and trained to proficiency in the skills needed to manage normal (i.e. uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of women and neonates for complications. https://www.who.int/data/nutrition/nlis/info/births-attended-by-skilled-health-personnel#:~:text=A%20skilled%20birth%20attendant%20is,the%20identification%2C%20management%20and%20referral

[2] According to WHO 2023 report https://www.who.int/news/item/23-02-2023-a-woman-dies-every-two-minutes-due-to-pregnancy-or-childbirth--un-agencies

[3] The World Bank defines a health facility as: A physical structure, varying from a large complex of buildings to a single room in a house, from which health services are offered by a doctor, nurse, or midwife.

[4] The global MMR had already fallen from 339 maternal deaths per 100 000 live births to 227 by 2015, but has remained at 223 between 2016 and 2020. https://iris.who.int/bitstream/handle/10665/366225/9789240068759-eng.pdf?sequence=1

[5] ACLED Conflict Index: https://acleddata.com/conflict-index/#:~:text=The%20world%20is%20getting%20far,both%20Afghanistan%20and%20Syria%20raged.

[6] Save the Children press release on number of attacks on health facilities in Gaza since October 2023 – April 2024: https://www.savethechildren.org.uk/news/media-centre/press-releases/rate-of-attack-healthcare-higher-in-gaza-than-other-conflict--gl

[7] Stop the War on Children 2023 report: https://resourcecentre.savethechildren.net/document/stop-the-war-on-children-let-children-live-in-peace/

[8] Child Atlas: https://www.childatlas.org/atlas

[9] The Damal Caafimaad Project https://projects.worldbank.org/en/projects-operations/project-detail/P172031

Methodology

The figures are calculations done by Save the Children UK’s research and data hub using publicly available demographic and health statistics. We use the latest available data points on births attended by a skilled health professional (%) and births in a health facility (%) from UNICEF Data.https://data.unicef.org/topic/maternal-health/delivery-care/ Projections on total new births in 2024 is taken from World Population Prospects - Population Division - United Nations. The analysis was performed using country-specific estimates from UNICEF of skilled birth attendance and births in health facilities, which were then aggregated to a global level. However, as a consequence, global numbers may vary slightly between our estimates and other published estimates. Countries affected by conflict are identified by the World Bank classification for Fragile and Conflict-Affected Situations for the current financial year. All figures are expressed in millions.