A woman living in a conflict-affected country’s risk of dying from maternal causes is about five times higher for each pregnancy she experiences compared to her peers living 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 contexts, representing six in ten maternal deaths globally, even though these countries account for only around one in ten live births globally.
Significant disparities in risks
The new technical note offers an analysis of why pregnant women living in some countries are more likely to die in childbirth and confirms what many practitioners are seeing on the ground: crises create conditions in which health systems cannot consistently provide lifesaving maternal care.
Indeed, 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 document produced by WHO and an inter-agency group that includes the UN development agencies, UNDP, sexual and reproductive health, UNFPA, and children, UNICEF, as well as the World Bank.
The disparity in risks is glaring. In 2023, a 15-year-old girl living in a country or territory affected by conflict had a one-in-51 risk of dying from a maternal cause, compared to a one-in-79 risk in a country or territory affected by institutional and social fragility, and a one-in-593 risk for a 15-year-old girl living in a relatively stable country.
Global progress has stalled
The report aligns the latest estimates of the maternal mortality rate according to whether a country is affected by conflict 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 the two categories recorded a much lower rate of 99.
These findings deepen the picture provided by last year’s maternal mortality estimates for 2000 to 2023, which showed that global progress had stalled and that maternal mortality remained incredibly high in low-income and crisis-affected contexts, prompting this deeper analysis.
Innovative approaches help
The publication also offers case studies of how frontline teams are working to maintain maternal health services amid instability, with solutions showing that even when 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 in the face of security threats, and coordination mechanisms evolve to ensure continuity of care.
Here are some examples:
Colombia: Training traditional birth attendants shows how strengthening trusted local networks can ensure timely care even when access is limited due to geography, insecurity or mistrust, establishing continuity of care through mobile teams, renovated facilities and additional midwives.
Ethiopia: The focus is on practical measures that help restore services after a disruption by restoring continuity of care through mobile teams, renovated facilities and additional midwives.
Haiti: The efforts demonstrate the importance of removing cost and infrastructure barriers, with free or low-cost C-sections and reliable power, allowing displaced women to access life-saving care who otherwise would not have access.
Myanmar, Papua New Guinea and Ukraine: Initiatives show that, even in a complex crisis or conflict context, women benefit when systems focus on protecting essential maternal services, whether through planning at the subnational level, improving respectful and safe birthing practices, or reorganizing patient pathways to safer facilities.
Using data to take action
By linking maternal mortality rate data to frailty classification, WHO and partners now have a more accurate tool to identify areas where health system strengthening is most urgent.
The brief highlights the importance of:
- investing in primary health care to maintain essential maternal services during crises
- strengthening data collection in hard-to-access settings to ensure no deaths go unnoticed
- support the design of a resilient health system, 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.
