Conflict Increases Risks Associated with Pregnancy

Nearly two-thirds of all maternal deaths worldwide occur in countries marked by conflict or instability. The risk of a woman living in a conflict-affected country dying from maternal causes is approximately five times higher for each pregnancy she experiences compared to her counterparts in stable nations.

A new technical brief provides an analysis of why pregnant women in certain countries face a higher risk of dying during childbirth.

In 2023 alone, it is estimated that 160,000 women died from preventable maternal causes in fragile and conflict-affected settings, representing 6 in 10 maternal deaths worldwide, even though these countries account for only about one in ten of global live births.

The brief from the World Health Organization (WHO) and HRP (the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction) aligns the most recent maternal mortality ratio (MMR) estimates with a country’s status as conflict-affected or classified as fragile.

Countries classified as conflict-affected had an estimated maternal mortality ratio (MMR) of 504 deaths per 100,000 live births, while countries considered institutionally and socially fragile had an MMR of 368. In contrast, countries outside both categories experienced a significantly lower MMR of 99.

These findings enhance the insights given in last year’s maternal mortality estimates from 2000 to 2023, which revealed that global progress has stagnated and that maternal mortality rates remain alarmingly high in low-income and crisis-affected areas, prompting this further analysis.

This new analysis confirms what many practitioners observe in the field: crises create conditions where health systems struggle to consistently provide lifesaving maternal care. The brief also highlights that the intersection of gender, ethnicity, age, and migration status can elevate the risks faced by women and girls who are both pregnant and living in fragile contexts.

The disparity of risk is stark: a 15-year-old girl living in a country or territory affected by conflict in 2023 had a 1 in 51 lifetime risk of eventually dying from a maternal cause, compared with a 1 in 79 risk in a country or territory affected by institutional and social fragility, and 1 in 593 for a 15-year-old girl living in a relatively stable country.

The publication also presents case studies illustrating how frontline teams are working to sustain maternal health services in the face of instability. Solutions from Colombia, Ethiopia, Haiti, Myanmar, Papua New Guinea, and Ukraine demonstrate that even in situations where health systems are under severe strain, innovative strategies can safeguard maternal health. These examples show communities tailoring services to meet cultural needs, health workers reinstating disrupted services, hospitals restructuring care amid security challenges, and coordination mechanisms developing to ensure the continuity of care.

In Colombia, training traditional birth attendants demonstrates how bolstering trusted local networks can guarantee timely care, even in areas where access is restricted due to geography, insecurity, or mistrust. This involves establishing continuity of care through mobile teams, renovated facilities, and the addition of more midwives.

In Ethiopia, the focus is on reinstating continuity of care through mobile teams, renovated facilities, and additional midwives. These are practical steps that assist in restoring services after disruption.

Haiti demonstrates the importance of removing cost and infrastructure barriers, with free or low-cost caesarean sections and reliable electricity, making lifesaving care available to displaced women who would otherwise have no access.

Myanmar, Papua New Guinea, and Ukraine demonstrate that even in the midst of complex crises or conflict, women benefit when systems prioritize the protection of essential maternal services. This can be achieved through planning at the subnational level, enhancing respectful and safe childbirth practices, or restructuring patient pathways to ensure safer access to facilities.

By connecting maternal mortality rate (MMR) data to the fragility classification, the Health Resilience Partnership (HRP), the World Health Organization (WHO), and their partners now possess a more precise tool to identify where health system strengthening is most urgently needed. The report underscores the necessity of investing in primary health care to sustain essential maternal services during crises; enhancing data collection in hard-to-reach areas to ensure that no deaths are unrecorded; and promoting the design of resilient health systems that can withstand and adapt to unexpected challenges.

Together, these efforts can help accelerate progress toward reducing preventable maternal deaths, even in the world’s most challenging environments.