The risk of a woman who lives in a country affected by conflict dying due to maternal causes is around 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 from preventable maternal causes in fragile and conflict-affected settings, that is six in 10 maternal deaths worldwide, despite these countries accounting for only around one in 10 of global live births.
Stark risk disparities
The new technical brief offers analysis as to why pregnant women living in certain countries are more likely to die in childbirth and confirms what many practitioners see on the ground: crises create conditions where health systems cannot consistently deliver lifesaving maternal care.
Indeed, the intersection of gender, ethnicity, age and migration status can increase the risk women and girls face who are both pregnant and living in fragile contexts, according to the brief, produced by WHO and an inter-agency group that includes the UN agencies for development, UNDP, sexual and reproductive health, UNFPA, and children, UNICEF, as well as the World Bank.
The disparity of risk is stark. 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 from 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 aligns the latest maternal mortality ratio estimates with whether a country is conflict-affected or considered fragile.
Countries classified as conflict-affected had an estimated maternal mortality ratio 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 provided in last year’s maternal mortality estimates for 2000 through 2023, which showed that global progress has stalled and that maternal mortality remains staggeringly high in low-income and crisis-affected settings, which spurred this further analysis.
Innovative approaches are helping
The publication also offers case studies of how frontline teams are striving 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 are adapting services to cultural needs, health workers are restoring disrupted services, hospitals are re-organising care under security threats and coordination mechanisms are evolving 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, renovated facilities and additional midwives.
Ethiopia: The emphasis is practical measures that help restore services after disruption by re-establishing continuity of care through mobile teams, renovated facilities and additional midwives.
Haiti: Efforts demonstrate the importance of removing cost and infrastructure barriers, with free or low-cost caesarean sections and reliable electricity power, making lifesaving care available to displaced women who would otherwise have no access.
Myanmar, Papua New Guinea and Ukraine: Initiatives show that, even amid complex crises or conflict, women benefit when systems focus on protecting essential maternal services, whether through planning at subnational level, improving respectful and safe childbirth practices or reorganising 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 brief emphasises the importance of:
- investing in primary healthcare to maintain essential maternal services during crises
- strengthening data collection in hard-to-reach settings to ensure no deaths go uncounted
- supporting resilient health system design able to absorb and adapt 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 UN health agency.
Learn more about what WHO is doing here.
