PROGRESS IN LOWERING maternal mortality rates have stagnated across much of the world and, in some regions, are getting worse. A report by the World Health Organization (WHO)WHO) published in February showed that the number of pregnant women who died per 100,000 births increased by 3.8% per year in Europe between 2016 and 2020. In the same period mortality rose by 3.5% per year in Latin America and the Caribbean, and 2.9% in North America. In other poorer regions, for the first time in decades, there was a significant improvement in development.
About 70% of maternal deaths in 2020 occurred in sub-Saharan Africa. According to the latest figures, one in 40 women in the region dies during pregnancy or childbirth. Poverty is largely to blame. Many women do not have access to health care to deal with problems when they arise. Child marriage is also common. In some parts of the region 20% of women give birth before their 16th birthday, raising the risk of serious complications.
Between 2000 and 2015 maternal mortality rates across Africa fell by around 2.2% per year. But since 2016 the annual drop has slowed to 1.7%. Progress is stalling elsewhere too. In Asia the rate has fallen by more than 60% since 2000. But after 2016 annual developments were about a third of what they were between 2000 and 2015. The reasons for this are still unclear. The pandemic has undoubtedly made pregnancy more dangerous, due to the risk of covid-19 itself and the strain it has placed on healthcare resources. But that only helps explain one year of data. Public health experts have not yet determined what other factors have been present since 2016.
In some parts of the world progress has been reversed. In percentage terms, Europe saw the biggest increase of any region in the maternal death rate between 2016 and 2020 (although it remains the safest region to be pregnant or give birth). Mortality increased in Latin America and the Caribbean, after more than a decade of improvements. Many countries in the region suspended or restricted access to maternal health services during the pandemic. The WHOthe next update could be even sharper, as the full toll of the pandemic becomes apparent.
America is an outlier in the rich world. Unlike most other countries it has recorded a steady rise in mortality rates for the past two decades, not just since 2016. Black women are disproportionately affected: studies have show that they are three times more likely to die during pregnancy than white women. The WHOFigures show that the risk to women in America was 78% higher in 2020 than in 2000. But the American data is skewed because, between 2003 and 2017, the way they recorded mortality rates changed maternal New death certificates have been introduced which show whether a woman was pregnant at, or shortly before, her death – regardless of the cause. A report published in 2020 found that there was no difference in the maternal mortality rate between 1999 and 2017 when controlling for the adoption of these new death certificates. There are warnings on the WHO report However, overall, it provides a grim assessment of the risks facing pregnant women around the world.■
