Fatioma, a 30-year-old pregnant refugee from Sudan, sits with her daughter in a camp in Chad, a stark illustration of a global crisis where conflict and instability are dramatically increasing the risk of maternal death. A new report from the World Health Organization (WHO) reveals a deeply troubling trend: over 60% of maternal deaths in 2023 occurred in countries and territories grappling with conflict or fragile institutions. The statistics are a sobering reminder that maternal mortality isn’t simply a medical issue, but a consequence of systemic failures exacerbated by violence and displacement.
An estimated 260,000 women died from causes related to pregnancy and childbirth in 2023, according to the WHO report published on Tuesday. Alarmingly, around 160,000 of these deaths occurred in settings marked by conflict or institutional fragility. This isn’t a matter of lacking medical solutions, but rather a failure to provide consistent, accessible healthcare in areas where it’s needed most. The report underscores the urgent need to address the structural weaknesses in health systems that leave women vulnerable, particularly in crisis situations. Protecting maternal health in fragile settings is paramount, and requires sustained investment and a commitment to safeguarding healthcare access.
The Disproportionate Impact of Conflict on Maternal Mortality
The maternal mortality ratio in countries directly affected by conflict reached 504 maternal deaths per 100,000 live births in 2023, a significantly higher rate than the 99 deaths per 100,000 seen in countries not facing these challenges. Fragile settings as well experience a higher rate, with 368 deaths per 100,000 live births. These figures highlight the devastating impact of disrupted services, damaged hospitals, and the displacement of healthcare workers. As WHO sexual and reproductive health scientist Jenny Cresswell explained during a media briefing in Geneva, “The overwhelming majority of these deaths can be prevented.”
The preventable nature of these deaths is particularly poignant. The report details how factors like hemorrhage, hypertensive disorders such as pre-eclampsia, infections, and complications from unsafe abortion contribute to maternal mortality in conflict zones. These are conditions that are largely treatable with appropriate medical care, yet women are often unable to access it due to violence, logistical challenges, or the collapse of healthcare infrastructure. The risk is particularly acute for young women; a 15-year-old girl living in a conflict-affected country in 2023 faced a 1 in 51 lifetime risk of dying from a maternal cause, compared to a 1 in 593 risk for a girl in a stable country.
Concentrated Crisis: Where Maternal Deaths Occur
The burden of maternal mortality is not evenly distributed. Approximately 10% of women of reproductive age reside in the 17 countries and territories classified as experiencing conflict by the World Bank, yet these areas account for 21% of all live births and a staggering 55% of all maternal deaths. Similarly, the 20 countries and territories with institutional and social fragility are home to just 2% of women of reproductive age, but contribute to 4% of all live births and 7% of all maternal deaths. This concentration underscores the need for targeted interventions in these vulnerable regions.
Progress and Innovation in Ethiopia
Despite the grim statistics, the WHO report also offers a glimmer of hope, demonstrating that progress is possible even in challenging circumstances. Ethiopia, for example, saw its maternal mortality ratio (MMR) decrease from 267 to 195 maternal deaths per 100,000 live births between 2020 and 2023. However, pregnant women in conflict-affected regions – Tigray, Amhara, Afar, and Oromia – continue to face significant obstacles to accessing essential maternal health services, including limited ambulance availability, restrictions on nighttime travel, and the departure of healthcare workers.
In response, the WHO, UNICEF, and UNFPA, with funding from the Bill & Melinda Gates Foundation, launched the Service Delivery Innovations in Conflict-Affected Areas (SDI) project in Amhara, Oromia, and Afar. This initiative has deployed three ambulances and six mobile health teams to underserved communities, renovated 24 maternity waiting homes, six neonatal intensive care units, and four maternity wards, and trained and deployed 24 midwives. The results have been promising: deliveries attended by skilled health workers increased from 12,790 to 17,620 between 2022 and 2024, and antenatal care visits rose from 15,636 to 23,228 during the same period. Postnatal care visits within seven days of delivery also increased, from 17,611 to 21,730.
The Path Forward: A Global Commitment
Despite these localized successes, the world is currently off track to meet its goal of reducing maternal mortality to fewer than 70 deaths per 100,000 live births by 2030. As Cresswell emphasized, “We must protect maternal health in fragile settings. That means investing in primary health care, protecting health workers and facilities, ensuring emergency obstetric services remain functional during crisis.” The WHO report recommends improving data collection on maternal and newborn mortality, particularly in areas with limited humanitarian access, to better identify inequities and track progress.
The challenge is clear: ensuring that no woman loses her life giving life requires a sustained, coordinated global effort. Investing in resilient health systems, protecting healthcare workers, and prioritizing access to essential maternal services, even – and especially – in the midst of conflict and instability, are critical steps towards achieving this fundamental human right. Continued monitoring and evaluation of interventions, like the SDI project in Ethiopia, will be essential to refine strategies and maximize impact.
This is a complex issue demanding ongoing attention and collaborative action. Share your thoughts and experiences in the comments below.
Disclaimer: This article provides informational content about public health and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider for any questions you may have regarding your health.
