More than 700 women die every day from complications related to pregnancy or childbirth, while approximately 2.3 million babies die before reaching one month of age each year — around 6,200 a day. Most of these deaths are preventable, yet a child’s and mother’s chances of survival remain closely tied to where they live and the medical care available to them.
The latest figures from the World Health Organization (WHO) show the scale of the disparity. Seven in 10 women who die from pregnancy- or childbirth-related causes live in Africa. The neonatal mortality rate in sub-Saharan Africa is 11 times that of Australia and New Zealand, reflecting profound differences in access to healthcare during pregnancy, delivery and the first days of life.
“Ending preventable deaths among mothers and children is not only a health priority, but a matter of equity,” said Yulio Rakotonirina, head of health and humanitarian affairs at the African Union, during the World Health Summit in Berlin.
Many of the interventions needed to prevent these deaths are already established. They include regular antenatal check-ups, vaccination, adequate nutrition and supplements during pregnancy, early detection of complications, skilled assistance during childbirth and essential newborn care. But millions of women in countries with fragile health systems still lack access to these services.
Improving maternal nutrition alone could have a substantial impact. A multiple-micronutrient supplement promoted by the United Nations costs about $2.60 for a complete pregnancy course. If made available to pregnant women in low- and middle-income countries, it could help save nearly half a million lives annually.
“The problem is not that we do not know what works. We know which interventions save lives,” said Inger Ashing, chief executive of Save the Children International. The difficulty, she argued, is that policies are often designed for ideal healthcare systems rather than the conditions in which medical staff and patients actually operate.
Ashing pointed to Yemen, where many health facilities face shortages of professionals, medicines and equipment, as well as fuel needed to keep services running. Humanitarian crises, she warned, account for a growing share of maternal and child deaths worldwide.
The geographical divide is stark. WHO estimates put maternal mortality at about 993 deaths per 100,000 live births in Nigeria, 747 in Chad, and 691 in both South Sudan and the Central African Republic. Afghanistan records 520 deaths per 100,000 live births, compared with just three in Spain.
For newborns, sub-Saharan Africa records 27 deaths per 1,000 live births, against 2.4 in Australia and New Zealand. Nearly half of neonatal deaths occur in sub-Saharan Africa. Complications associated with premature birth, infections and difficulties during delivery account for many deaths in the first 28 days, when babies are particularly vulnerable. Around two million babies are also stillborn every year, with four in five such deaths occurring in sub-Saharan Africa and South Asia, according to the International Confederation of Midwives. The organisation estimates that close to half could be prevented.
A shortage of skilled birth attendants compounds the problem. The confederation estimates a global deficit of nearly one million midwives. Jackeline Dunkley-Bent, its chief midwife, said women who lose babies ask the same questions everywhere, but their circumstances determine whether help is available. In countries with strong healthcare infrastructure, she said, women know where to turn when complications arise; elsewhere, “there is nobody to turn to”.
Global progress in child survival has nevertheless been substantial. Annual deaths among children under five fell from about 13 million in 1990 to 4.9 million in 2024, a reduction of 63%, according to estimates from Unicef and the UN Inter-agency Group for Child Mortality Estimation. But the pace of improvement has slowed: the annual decline is now two-and-a-half times slower than in the early years of this century.
Cuts to international aid threaten to reverse some of those gains. The Gates Foundation’s Goalkeepers 2025 report warned that child deaths could rise for the first time this century, projecting more than 200,000 additional deaths among children under five each year as international funding falls.
For Ashing, the central challenge is translating established evidence into care that reaches those who need it: “evidence must become policy, policy must reach health workers, and health workers must reach mothers and children”.
