By Etienne V. Langlois, Amy Reid and Rajat Khosla
In 2023, an estimated 712 women died each day due to complications during and after pregnancy and childbirth, totalling approximately 260,000 maternal deaths over the year.1 More than two-thirds (70%) of maternal mortality occurred in Sub-Saharan Africa.1 These deaths were largely due to direct causes, including postpartum haemorrhage, hypertensive disorders, unsafe abortion, and sepsis,2 which can be prevented or treated.
Compounding challenges arising from conflict and fragile settings and the growing burden of non-communicable diseases are impacting health in pregnancy and beyond.1 If the current pace of progress of the Sustainable Development Goal (SDG) era continues, by 2030 the global maternal mortality ratio will be 2.5 times higher than the target of fewer than 70 maternal deaths per 100,000 live births.1
There is, however, high hope on the horizon. Since the year 2000, maternal mortality has decreased by 40%.1Evidence-based solutions exist, and we have the tools necessary to reverse this crisis. What is needed now is an unwavering political will to implement these proven solutions at scale.
Political leadership is key
Political leadership is crucial for accelerating the reduction in maternal mortality. In 2022, recognizing the high rate of maternal mortality in the country, the Government of Sierra Leone declared maternal mortality a Public Health Emergency,3 mobilizing resources and triggering a coordinated multi-sectoral response. Accountability was central to this strategy, through updated Maternal and Perinatal Death Surveillance and Response guidelines, the development of an incidence management system and situation room to track each maternal death and tackle the root causes. This leadership example illustrates how political will is a key driver of progress.
Integration of high-quality interventions
Life-saving interventions exist, but their impact depends on large-scale implementation to improve access, quality, and equity through evidence-based service delivery models. Since most maternal deaths occur during labour or in the first 24 hours after birth ,1 strengthening postnatal care (PNC) alongside antenatal (ANC) and intrapartum care is critical. Providing high-quality commodities is essential to addressing postpartum hemorrhage (PPH), the leading cause of maternal death worldwide. Ensuring wider access to essential treatments like heat-stable carbetocin (HSC) and tranexamic acid (TXA) is vital, particularly in low-resource settings.4 Access to magnesium sulfate—the first-line treatment for eclampsia and severe pre-eclampsia—is also essential, as hypertensive disorders are the second leading direct cause of maternal deaths
Quality of care is a fundamental issue to address, and greater efforts are required to measure care quality and strengthen accountability. Investments are needed to enhance the collection and use of reliable, real-time data on service readiness, provision, and quality of care. Digital tools like electronic health records, mobile health platforms, and data analytics can play a transformative role for timely decision-making and resource allocation.
Accountability for WHA77 commitments
Support is needed to ensure the implementation of the WHA77 Resolution to accelerate progress towards SDGs 3.1 and 3.2.5 The resolution noted the urgent need to strengthen human resources for health, including nurses, midwives and community health workers. For example, scale up to universal coverage of midwife-delivered interventions could result in a two-thirds (67%) reduction in maternal deaths over a period of 15 years.6 Essential maternal health services should also be costed and prioritized in national health strategies and primary health care packages.
Upholding maternal health financing
The landscape of global health financing is shifting, with growing uncertainty in international support and threats to multilateralism. Simultaneously, pushback on sexual and reproductive health and rights (SRHR) risks reversing hard-won gains, limiting access to life-saving services for women and adolescents worldwide. Securing sustainable financing for essential services is more important than ever, including equity-enhancing investments targeting the most vulnerable communities. Evidence shows a high return on investment. For example, in 55 countries, expanding Basic Emergency Obstetric and Newborn Care (BEmONC) to 90% coverage, along with increased family planning, could yield up to US$87 for every US$1 spent across 5 years.7
To ensure adequate financing, it is essential to address the decline in international aid and improve its alignment with the Lusaka Agenda,8 alongside strong domestic resource mobilization. Domestic public spending on health per capita decreased in all country income groups in 2022, while out-of-pocket expenses continue to be the primary source of funding in 30 low- and lower-middle income settings.9 Reducing out-of-pocket payments through financial protection schemes and universal health care plans is crucial to ensuring access to life-saving services and reducing maternal mortality.
Prioritizing emergencies and humanitarian settings
Explicit attention must also be paid to women and girls in humanitarian and fragile contexts. In 2023, almost two-thirds (64%) of all maternal deaths occurred in conflict-affected or fragile countries.1 Global responses to emergencies and humanitarian crises must prioritize equity-enhancing efforts in regions with the highest maternal mortality, particularly sub-Saharan Africa and South Asia. Strategies to prevent maternal mortality and morbidity should be integrated into humanitarian response and Pandemic Prevention, Preparedness, and Response (PPPR) plans. Given the impact of climate change, heat stress, and air pollution on pregnancy – including associations with gestational diabetes and pre-eclampsia10 – maternal health should also be prioritized in climate adaptation plans to address these emerging threats.
A better future for mothers
While progress in reducing maternal mortality is commendable, urgent action is still needed to safeguard the lives of the most vulnerable women and girls. A global, evidence-based approach is essential to accelerate change and confront this ongoing crisis with the urgency it demands. Rhetoric alone will not save lives—only sound policies and sustained investments will. The choices made today will shape the survival, health, and future of millions of women and the communities that depend on them.
The authors are technical experts at The Partnership for Maternal, Newborn and Child Health (PMNCH), hosted by the World Health Organization (WHO).*This commentary was originally published in The Lancet* Corresponding author: langloise@who.int
