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A shifting burden

Challenges emerge as progress is made

Maternal health is a major development issue. Every year, 210 million women become pregnant and 140 million babies are born.

Standards of living and levels of development are rising across the world, and some of the more serious problems of poverty are becoming less common. Fewer mothers and babies in low-income countries are now dying in childbirth or the period immediately after.

This is important progress, but it also means that the predominant causes of death are changing, and non-communicable diseases and non life-threatening problems that can accompany pregnancy—including problems around mental health —are increasingly visible. Many of the women affected live in conditions where support is hard or impossible to get.

By 2030, the sustainable development goals aim—among other things—to:

  • Reduce the global average of maternal deaths to less than 70 per 100,000 live births, with no country above 140 per 100,000
  • End preventable deaths of newborns and children under five, with all countries reducing neonatal deaths to 12 or fewer per 1,000 live births
  • Reduce deaths of children under five to at least as low as 25 per 1,000 live births.

This cannot be achieved unless maternal health is improved for everyone, everywhere.

To achieve this, we need high quality data on maternal health that take into account vulnerability, allowing us to monitor inequality and come up with new policies and programmes to address it.

What’s changing?

More prosperity also means changing lifestyles. Low-income countries are starting to experience some of the health problems that high-income countries have had for a long time. Common changes as standards of living improve include women having their first child at a later age; increases in obesity, diabetes, heart disease and other chronic conditions; and a greater demand for facility delivery and medical technologies, and sometimes for more woman-centred health services. Increasing urbanization poses some advantages for maternal health, but also challenges. Countries’ health systems are struggling to cope with growing and diversifying populations.

More broadly, external shocks, including climate change, natural disasters, and increasing environmental damage impact health for everybody, but women—who are already subject to gender discrimination, and who then have to bear a greater burden of coping and recovering—often feel the effects worst.

Who is affected?

Changes in the nature and number of problems affecting mothers mean countries’ health systems and policies are struggling to keep up.

Vulnerable women are hit the hardest. Some of the worst affected are the women who face discrimination on the basis of their age, marital status, ethnicity, or cultural or religious beliefs; who are poor or who live in remote areas; who live in fragile states with weak governments; or who are affected by disasters or other crises (especially if they are migrants, internally displaced or refugees). These women are falling through the gaps.

Despite overall progress, improvement around the world is patchy, both inside countries and between them. Between 1990 and 2013, the gap between the countries with the lowest numbers of maternal deaths and the countries with the highest increased from around 100 times difference, to 200 times. Inequity is increasing. The SDGs promise “to leave no one behind,” but substantial work needs to be done to make this a reality for maternal health.

Women often left out of good quality care

  • Adolescents and unmarried women
  • Immigrants
  • Refugees and internally displaced women
  • Indigenous women and ethnic or religious minorities
  • Women living in poverty
  • Women living in informal urban settlements
  • Women in remote areas
  • Women living in fragile states or affected by humanitarian crises