Two pregnant women in a hospital in Kyiv, Ukraine. (archive) Pregnancy in conflict situations is a threat to the life of mother and child Health
Almost two thirds of all maternal deaths worldwide occur in countries affected by conflict or political instability. The risk of death due to pregnancy and childbirth for women living in such countries is approximately five times higher for each pregnancy compared to countries where stability reigns.
This is according to a new technical review prepared by the World Health Organization (WHO) and the Special Program for Research, Development and Scientific Training in Human Reproduction.
Crisis situations
It is estimated that only in 2023, in conditions of conflict and instability from preventable causes related to pregnancy and childbirth, About 160 thousand women died – this is six out of ten maternal deaths in the world. However, such countries account for only about one tenth of all live births.
According to the analysis, in states classified as conflict-affected, the maternal mortality rate was 504 per 100,000 live births. In countries with pronounced institutional and social instability – 368 per 100 thousand. For comparison, in countries outside these categories the rate is much lower – 99 per 100 thousand.
These data complement previously published global estimates for 2000–2023, which showed that progress in reducing maternal mortality has slowed and rates remain extremely high in low-income countries and in crisis settings.
Inequality and weak systems
The authors emphasize that conflict and instability create conditions in which health systems are unable to routinely provide life-saving care to pregnant women. However, additional factors – gender, ethnicity, age and migration status – may further increase risks.
Inequality is especially noticeable among teenagers. In 2023, one in 51 girls aged 15 years living in a conflict-affected country was at risk of dying from pregnancy and childbirth-related causes in their lifetime. In countries with institutional instability, every 79th person had such a risk, and in relatively prosperous countries, only every 593rd person had such a risk.
Practical solutions
The publication also provides examples of countries where health workers are trying to provide maternal health services despite instability. Among them are Colombia, Ethiopia, Haiti, Myanmar, Papua New Guinea and Ukraine.
In Colombia, midwifery training helps provide timely care in remote areas where access to health facilities is limited due to geography or dangerous conditions.
In Ethiopia, the emphasis is on restoring continuity of care – through mobile teams, renovation of health facilities and the recruitment of additional midwives.
In Haiti, removing barriers is important, providing free or discounted services to women forced to flee their homes. Efforts are also being made to ensure stable power supply in maternity hospitals.
Myanmar, Papua New Guinea and Ukraine are demonstrating that even in protracted crises, maternal health can be protected – through regional planning, improving the quality and safety of obstetric care and reorganizing routes for patients who need to travel to hospital.
Action plan
By linking maternal mortality rates to levels of instability, experts have a more precise tool for identifying countries where the most urgent action is needed.
This is about investing in primary health care, collecting data in hard-to-reach areas and creating health systems that can adapt to crises. According to the authors, it is precisely such measures that will help reduce maternal mortality rates more quickly – even in the most difficult conditions.