The risk of a woman living in a conflict-affected country dying from maternal causes is about five times higher for each pregnancy she undergoes compared to her peers in stable countries, according to new findings in the WHO report.
In 2023 alone, an estimated 160,000 women died of preventable maternal causes in fragile and conflict-affected settings, accounting for six in 10 maternal deaths worldwide, despite these countries accounting for only about one in 10 global live births.
Large risk differences
The new technical brief offers analysis of why pregnant women living in certain countries are more likely to die in childbirth and confirms what many practitioners are seeing on the ground: Crises create conditions where health systems cannot consistently deliver life-saving maternal care.
In fact, the intersection of gender, ethnicity, age and migration status can increase the risk faced by women and girls who are both pregnant and living in fragile contexts, according to the brief, prepared by WHO and an inter-agency group that includes UN agencies for development, UNDP, sexual and reproductive health, UNFPA and children, the World Bank, as well.
The difference in risk is large. A 15-year-old girl living in a country or territory affected by conflict in 2023 had a one-in-51 lifetime risk of eventually dying of a maternal cause, compared with a one-in-79 risk in a country or territory affected by institutional and social fragility, and one in 593 for a 15-year-old girl living in a relatively stable country.
Global progress has stalled
The report correlates the latest estimates of the maternal mortality rate with whether a country is conflict-affected or considered fragile.
Countries classified as conflict-affected had an estimated maternal mortality rate of 504 deaths per 100,000 live births, while in countries considered institutionally and socially fragile it was 368. In contrast, countries outside both categories saw a much lower ratio of 99.
These findings deepen the picture of last year’s maternal mortality estimates for 2000 to 2023, which showed that global progress has stalled and that maternal mortality remains staggeringly high in low-income and crisis-affected settings, prompting this further analysis.
Innovative approaches help
The publication also offers case studies of how frontline teams strive to maintain maternal health services amid instability, with solutions showing that even where health systems face extreme pressure, innovative approaches can protect maternal health.
Communities adapt services to cultural needs, health workers restore disrupted services, hospitals reorganize care under security threats, and coordination mechanisms evolve to ensure continuity of care.
Here are a few examples:
Colombia: Training traditional birth attendants shows how strengthening trusted local networks can ensure timely care even where access is limited due to geography, insecurity or mistrust through establishing continuity of care through mobile teams, refurbished facilities and additional midwives.
Ethiopia: Emphasis is placed on practical measures to help restore services after disruption by re-establishing continuity of care through mobile teams, refurbished facilities and additional midwives.
Haiti: The effort demonstrates the importance of removing cost and infrastructure barriers with free or low-cost C-sections and reliable electricity, making life-saving care available to displaced women who would otherwise not have access.
Myanmar, Papua New Guinea and Ukraine: Initiatives show that women, even in the midst of complex crises or conflicts, benefit when systems focus on protecting essential maternal services, whether through planning at the subnational level, improving respectful and safe birth practices, or reorganizing patient pathways to safer facilities.
Using data for action
By linking maternal mortality ratio data to the fragility classification, WHO and partners now have a more precise tool to identify where health system strengthening is most urgently needed.
The map emphasizes the importance of:
- invest in primary health care to maintain essential maternal services during crises
- strengthening data collection in hard-to-reach settings to ensure no deaths are missed
- supports a robust health system design capable of absorbing and adapting to shocks
Together, these efforts can help accelerate progress toward reducing preventable maternal deaths, even in the world’s most challenging environments, according to the United Nations health agency.
Learn more about what WHO does here.
