Nearly two-thirds of maternal deaths worldwide occur in countries affected by conflict or fragility, where the risk of dying from maternal causes is about five times higher per pregnancy compared with women in stable countries. In 2023, an estimated 160,000 women died from preventable maternal causes in fragile and conflict-affected settings, accounting for six in ten maternal deaths globally, despite these countries representing only about one in ten of all live births.
A new technical brief from the World Health Organization and HRP analyzes why women in these contexts face higher risks, showing that countries classified as conflict-affected had a maternal mortality ratio (MMR) of 504 deaths per 100,000 live births, while socially and institutionally fragile countries had an MMR of 368, compared with 99 in stable countries. The analysis highlights that crises disrupt health systems, limiting access to lifesaving maternal care, and that factors such as gender, ethnicity, age, and migration status further increase risks for pregnant women and girls. For example, a 15-year-old girl in a conflict-affected country has a 1 in 51 lifetime risk of dying from maternal causes, compared with 1 in 79 in fragile countries and 1 in 593 in stable countries.
The brief also presents case studies from Colombia, Ethiopia, Haiti, Myanmar, Papua New Guinea, and Ukraine, demonstrating innovative approaches to maintain maternal health services amid instability. Strategies include training traditional birth attendants, deploying mobile health teams, renovating facilities, providing free or low-cost procedures, ensuring reliable electricity, reorganizing patient pathways, and tailoring services to local cultural needs. These examples show that even under extreme pressure, communities and health systems can adapt to protect maternal health.
By linking MMR data to fragility classifications, WHO, HRP, and partners can better target health system strengthening where it is most urgently needed. The brief emphasizes investing in primary health care, improving data collection in hard-to-reach areas, and designing resilient health systems capable of absorbing and adapting to crises. These efforts aim to accelerate progress in reducing preventable maternal deaths, even in the world’s most challenging environments.
