Maternal mortality

Every day, 1500 women die from pregnancy- or

childbirth-related complications. In 2005, there
were an estimated 536 000 maternal deaths
worldwide. Most of these deaths occurred in
developing countries, and most were avoidable.
(1)
Improving maternal health is one of the eight
Millennium Development Goals adopted by the
WHO/MPS/08.12

international community at the United Nations

Millennium Summit in 2000. In Millennium
Development Goal 5 (MDG5), countries have
committed to reducing the maternal mortality
ratio by three quarters between 1990 and 2015.
However, between 1990 and 2005 the maternal
Fact sheet

mortality ratio declined by only 5%. Achieving

Millennium Development Goal 5 requires
accelerating progress.
Where do maternal deaths occur?
The high incidence of maternal death is one of
the signs of major inequity spread throughout
the world, reflecting the gap between rich and
poor.
A total of 99% of all maternal deaths occur
in developing countries, where 85% of the
population lives. More than half of these deaths
occur in sub-Saharan Africa and one third in
South Asia. The maternal mortality ratio in
developing countries is 450 maternal deaths
per 100 000 live births versus 9 in developed
countries. Fourteen countries have maternal
mortality ratios of at least 1000 per 100 000
live births, of which all but Afghanistan are
in sub-Saharan Africa: Afghanistan, Angola,
Burundi, Cameroon, Chad, the Democratic
Republic of the Congo, Guinea-Bissau, Liberia,
Malawi, Niger, Nigeria, Rwanda, Sierra Leone
and Somalia.(1)
Because women in developing countries have
many pregnancies on average, their lifetime
risk more accurately reflects the overall burden
of these women. A woman’s lifetime risk of
maternal death is 1 in 7300 in developed
countries versus 1 in 75 in developing
countries. But the difference is more striking in
Niger, where women’s lifetime risk of dying from
pregnancy-related complications is 1 in 7 versus
1 in 48 000 in Ireland.(1)
In addition to the differences between
countries, there are also large disparities within
countries between people with high and low
income and between rural and urban popula-
tions.
Why do mothers die?
Women die from a wide range of complications
in pregnancy, childbirth or the postpartum
period. Most of these complications develop
because of their pregnant status and some
because pregnancy aggravated an existing
disease. The four major killers are: severe
bleeding (mostly bleeding postpartum),
infections (also mostly soon after delivery),
hypertensive disorders in pregnancy (eclamp-
sia) and obstructed labour. Complications
after unsafe abortion cause 13% of maternal
deaths. Globally, about 80% of maternal deaths
are due to these causes. Among the indirect
causes (20%) of maternal death are diseases
that complicate pregnancy or are aggravated
by pregnancy, such as malaria, anaemia and
HIV.(2) Women also die because of poor health
at conception and a lack of adequate care

1. Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007 (http://www.
who.int/reproductive-health/publications/maternal_mortality_2005/index.html, accessed 14 August 2008).
2. The world health report 2005 – Make every mother and child count. Geneva, World Health Organization, 2005 (http://www.who.int/whr/2005/en,
accessed 14 August 2008).
 Maternal mortality
needed for the healthy outcome of the pregnancy for
themselves and their babies.

How can the mothers’ lives be saved?

The first step for avoiding maternal deaths is to
ensure that women have access to family planning
and safe abortion. This will reduce unwanted
pregnancies and unsafe abortions.
Fact sheet

The women who continue pregnancies need care

during this critical period for their health and for the
health of the babies they are bearing. Most maternal
deaths are avoidable, as the health care solutions to
prevent or manage the complications are well known.
Since complications are not predictable, all women
need care from skilled health professionals, especially
at birth, when rapid treatment can make the differ-
ence between life and death. For instance, severe
bleeding after birth can kill even a healthy woman
within two hours if she is unattended. Injecting the
drug oxytocin immediately after childbirth reduces
the risk of bleeding very effectively.
need support in the weeks after the delivery.
Why do mothers not get the care they
need?
Data show that less than two thirds (62%) of women
in developing countries receive assistance from
a skilled health worker when giving birth.(5) This
means that 45 million home deliveries each year are
not assisted by skilled health personnel.
In high-income countries, virtually all women have
at least four antenatal care visits, are attended by
a midwife and/or a doctor for childbirth and receive
postnatal care. In low- and middle-income countries,
just above two thirds of women get at least one
antenatal care visit, but in some countries less than
one third have this or, as in Ethiopia, just 12%.(4)
Even fewer women have the birth attended by a
skilled health worker. The 63% average for low- and
middle-income countries covers large differences:
from 34% in eastern Africa to 93% in South America.
(3)

Sepsis – a very severe infection – is the second most

There are many reasons why women do not receive
frequent cause of maternal death. It can be elimi-
the care they need before, during and after child-
nated if aseptic techniques are respected and if early
birth. Many pregnant women do not get it because
signs of infection are recognized and treated in a
there are no services where they live, they cannot
timely manner. The third cause, eclampsia, emerges
afford the services because they are too expensive
as pre-eclampsia, a common hypertensive disorder,
or reaching them is too costly. Some women do
which can be detected during pregnancy. Although
not use services because they do not like how care
pre-eclampsia cannot be completely cured before
is provided or because the health services are not
the delivery, administering drugs such as magnesium
delivering high-quality care.
sulfate can lower a woman’s risk of developing
convulsions (eclampsia), which can be fatal. Another Further, cultural beliefs or a woman’s low status in
frequent cause of maternal death is obstructed society can prevent a pregnant woman from getting
labour, which occurs when the fetus’ head is too big the care she needs. To improve maternal health,
compared with the mother’s pelvis or if the baby is gaps in the capacity and quality of health systems
abnormally positioned. A simple tool for identifying and barriers to accessing health services must be
problems early in labour is the partograph, a graph identified and tackled at all levels, down to the
of progress of labour and the maternal and fetal con- community.
dition. Skilled practitioners can use the partograph to
recognize and deal with slow progress before labour What does WHO do to reduce maternal
becomes obstructed, and, if necessary, ensure that mortality?
Caesarean section is performed on time to save the
Maternal health is one of WHO’s priority areas. In
mother and the baby. For women to benefit from
2007, we celebrated – together with partners – the
those cost-effective interventions they must have
20th anniversary of Safe Motherhood, an initiative
antenatal care in pregnancy, in childbirth they must
that placed maternal mortality on the global agenda.
be attended by skilled health providers and they

3. Proportion of births attended by a skilled health worker – 2008 updates. Geneva, World Health Organization, 2008 (http://www.who.int/reproductive_health/
global_monitoring/data.html, accessed 14 August 2008).
4. WHO and UNICEF. Antenatal care in developing countries: promises, achievements and missed opportunities. WHO/UNICEF 2003 (http://www.who.int/reproductive_
health/global_monitoring/data.html.
2 Countdown to 2015. Tracking progress in maternal, newborn & child survival: the 2008 report. New York, United Nations Children’s Fund, 2008 (http://www.
countdown2015mnch.org/index.php?option=com_content&view=article&id=68&itemid=61, accessed 14 August 2008).

Through the Department of Making Pregnancy Safer,
WHO is providing guidance to countries for improving
maternal health. We assist countries in collaboration
with other parts of the Organization and experts in
WHO regional and country offices. We aim to reduce
maternal mortality by providing and promoting
evidence-based clinical and programmatic guidance.
In addition, WHO advocates for a social, political
and economic environment conducive to action in
Fact sheet
Maternal mortality
preterm and with low birth weight. About 20 million
(17%) are born with low birth weight. The exact
number is not known since only one third of babies
are weighed at birth.
Among the 133 million babies who are born alive
each year, 2.8 million die in the first week of life
and slightly less than 1 million in the following three
weeks. Neonatal tetanus is still killing 100 000 babies

countries.
A cornerstone of the WHO guidance is guidelines on
effective, efficient, safe and culturally appropriate
services. A set of guidelines under a common title
Integrated Management of Pregnancy and Childbirth
(IMPAC) assists countries in addressing the main
problems facing pregnant women and their newborn
infants. The guidelines are supported by other tools
that help countries’ implementation according to their
needs and capacity, such as how to set policies that
address country needs, tools for costing programmes
that will increase women’s access to the care they
need and methods and instruments for monitoring
what they are doing and for measuring progress
in reducing maternal mortality. We guide critical
actions that are necessary in countries to ensure that
enough well-trained midwives and doctors become
available.
WHO also promotes the involvement of individuals,
families and communities in increasing access to
high-quality care. To advance these approaches, staff
of the WHO Department of Making Pregnancy Safer
and WHO staff in the regions organize workshops
to orient health programme managers and provide
ongoing technical support to countries.
a year.
The patterns of babies’ deaths are similar to the pat-
terns of maternal deaths: large numbers in Africa and
Asia and very low numbers in high-income countries.
The rates vary from 7 per 1000 births in high-income
countries to 74 per 1000 births in central Africa.
Interventions for saving babies’ lives are very similar
to those that save maternal lives. Although the
underlying causes differ, poor maternal health and
lack of services are the most important factors.
Infants who survive either maternal or neonatal
complications have high morbidity and resulting
disability. At present it is too difficult to measure how
many disabled infants – infants with cerebral palsy,
mental retardation or visual or auditory impairment –
are among the survivors. Many are among the babies
who die later in infancy and childhood.
Maternal and perinatal deaths (stillbirths and first-
week deaths) together add up to 6.3 million lives lost
every year. Further, many women must live with an
obstetric fistula because of childbirth complications,
and many babies are disabled. This combined toll
that mother and babies are paying for inadequate
services should be considered when maternal
mortality is being discussed.

What about babies

Every year more than 133 million babies are born,
90% in low- and middle-income countries. When
their mother dies, the chance of their surviving is
meagre. Lack of maternal care is causing a large
burden of babies’ deaths and disability among
infants.
Every year 3 million babies are stillborn. Almost
one quarter of these die during birth. The causes of
these deaths are similar to the causes of maternal
deaths: obstructed or very long labour, eclampsia
and infection such as syphilis. Poor maternal health
and diseases that have not been adequately treated
before or during pregnancy contribute to intrapartum
death but also contribute to many babies born

Related publications
Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World
Health Organization, 2007 (http://www.who.int/reproductive-health/publications/maternal_mortality_2005/
index.html).
The world health report 2005 – Make every mother and child count. Geneva, World Health Organization, 2005
(http://www.who.int/whr/2005/en).

3
 Department of Making Pregnancy Safer
Department of Child and Adolescent Health and Development
Department of Gender, Women and Health
Department of Reproductive Health and Research

World Health Organization

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CH-1211 Geneva 27, Switzerland
Fax: +41 22 791 5853

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