Nearly two-thirds of all maternal deaths worldwide occur in countries marked by conflict or fragility. The maternal mortality ratio 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.
A new technical brief offers analysis as to why pregnant women living in certain countries are more likely to die in childbirth.
In 2023 alone, an estimated 160 000 women died from preventable maternal causes in fragile and conflict-affected settings, that is 6 in 10 maternal deaths worldwide, despite these countries accounting for only around one in ten of global live births.
The brief from World Health Organization (WHO) and HRP (the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction) aligns the latest maternal mortality ratio (MMR) estimates with whether a country is conflict-affected or considered fragile.
Countries classified as conflict-affected had an estimated MMR of 504 deaths per 100 000 live births, while countries considered institutionally and socially fragile had an MMR of 368. In contrast, countries outside both categories saw a much lower MMR of 99.
These findings deepen the picture provided in last year’s maternal mortality estimates 2000-2023, 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.
This new analysis confirms what many practitioners see on the ground: crises create conditions where health systems cannot consistently deliver lifesaving maternal care. The brief also identifies that 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.
The disparity of risk is stark: a 15-year-old girl living in a country or territory affected by conflict in 2023 had a 1 in 51 lifetime risk of eventually dying from a maternal cause, compared with a 1 in 79 risk in a country or territory affected by institutional and social fragility, and 1 in 593 for a 15-year-old girl living in a relatively stable country.
