Why are maternal mortality rates so high around the world? Here are 4 reasons

January 31, 2023


That’s how many women die each year from complications due to pregnancy and childbirth — one woman every two minutes.

What’s even more tragic is the fact that the majority of these deaths  are preventable.

Women living in extreme poverty are the least likely to receive adequate health care and most likely to experience maternal death. The main factors that prevent women from receiving or seeking care during pregnancy and childbirth are poverty, distance to facilities and lack of information.

Here, we share four reasons why maternal mortality rates are so high, and what you can do to address this global crisis.

1. Girls are having babies too young

Every three seconds, a girl in the world is married off. The economic upheavals brought on by COVID-19 and the war in Ukraine reversed much of the progress made for gender equality. As families fall deeper into poverty, girls’ futures are sacrificed.

Child marriage is not only destroying girls’ futures — it’s also threatening their lives. When a girl is forced into marriage, she’s more likely to experience domestic violence and early pregnancy.

Globally, the leading cause of death for adolescent girls ages 15-19 is complications from childbirth and pregnancy.

Mothers in this age bracket face a higher risk of seizures and systemic infections, particularly in the uterus, than mothers ages 20-24. Nearly 70% of abortions among girls ages 15-19 are performed in unsafe ways, resulting in health complications and even death. Increased marriage and pregnancy rates, combined with overburdened health systems, mean more girls’ lives are on the line.

Chanda, a 16-year-old girl from Indonesia, has witnessed firsthand the negative impact child marriage has had on her friends’ lives. After participating in Plan’s Choosing the Future project — an initiative that encourages girls to stay in school and avoid early marriage — Chanda is confidently advocating for her rights, and for the rights of other girls in her community.

“One of the impacts of child marriage is the loss of education,” Chanda, 16, says. “Girls drop out of school, are trapped in poverty and experience stunting, child mortality and premature births … For mothers, child marriage can result in maternal death, cervical cancer, preeclampsia, domestic violence, child abuse and poor parenting skills.”

Chanda, a 16-year-old girl from Indonesia, wears a pink shirt and smiles for the camera.
Chanda, 16, is determined to stay in school. "I will try my best to study to a high level and become a doctor.”

2. Restrictive laws make it harder to get care

Bodily autonomy — deciding for yourself what happens to your own body — should be a basic human right, not a privilege. But girls and young women are facing increasing threats to reproductive health care access, including abortion services, which could  put their lives at risk.

“The denial of sexual and reproductive health and rights is having devastating consequences on the bodies, lives and futures of girls and young women around the world,” Plan International global CEO Stephen Omollo says.

Here in the U.S., the Supreme Court decision to overturn Roe v. Wade is endangering the sexual and reproductive health rights of millions of American women and adolescent girls. Ten states, including Alabama, South Dakota and Texas, have banned all abortions, not allowing exceptions for rape or incest. Legal restrictions barring abortion services disproportionately affect girls from low-income families, who don’t have the money, transportation or time off from work to travel for an abortion.

When a girl is forced to give birth, not only is her life on the line, but the odds that she and her child will live below the federal poverty line quadruples.

According to the United Nations, close to half of girls and women in low-income countries do not “own their bodies.” They are denied the right to decide whether to have sex with their partners, to use contraception or to seek health care.

A major Stanford University study reported that the number of unsafe, life-threatening abortions actually increases in areas where sexual and reproductive health and rights are not protected. Roughly 97% of all unsafe abortions occur in low-income countries. Access to reproductive health care is now even more limited for millions of girls and women, and half of all abortions are happening in unsafe and sometimes life-threatening circumstances.

[Read more: There’s a war against sexual & reproductive health rights. Here’s what’s happening]

In Zambia, young people like Keira, who became pregnant during the COVID-19 pandemic in 2020, struggle to access sexual and reproductive health services.

“I didn’t know anything about contraceptives and was just told that they were for married people and if I used them, I would not have children in the future,” she explains.

But thanks to support from Plan donors, there are now adolescent-friendly health services available to Keira in her community.

“I usually visit the youth-friendly corner at the clinic,” Keira says. “They are a great support and I have learned many things about my sexual and reproductive health and rights. I would like to become an active member — a voice in our community so that no other girls will end up becoming pregnant and miss out on school.”

Keira, a pregnant woman in Zambia, leans against a pale blue wall.
“My dream is to become a doctor, nurse or midwife,” Keira says. “I would love to deliver my friends’ babies.”

3. Food is scarce

The world is in the grip of one of the most devastating hunger crises we’ve ever seen. And that’s especially bad for pregnant and lactating women, who are particularly vulnerable to malnutrition, increasing their risk of miscarriage, stillbirth, newborn death and maternal mortality.

“Globally, there are now 50 million people on the brink of starvation,” Plan International Global Humanitarian Director Dr. Unni Krishnan says. “Many of them, including infants and pregnant women, are teetering on the edge of famine.”

When we spoke to Sofia in Kenya, she was eight months pregnant. She could only afford one meal a day, putting both herself and her baby at risk.

“I go to bed hungry every night because there is nothing to eat,” Sofia says.

Sofia, a pregnant woman in Kenya, sits on a bench outside her local dispensary.
Sofia waits to be seen at her local dispensary where she receives food supplements.

Each day, hundreds of mothers like Sofia arrive at their local food dispensaries in hope of receiving super cereals or ready-to-use therapeutic food made of peanut butter paste.

“I have been working here for the last seven years and once the drought hit, the body weight of pregnant and breastfeeding mothers has been worrying,” nutritionist Mwanadie Omar explains. “The majority rely on the supplements we are offering at the dispensary, but we cannot sustain everybody.”

A recent survey conducted by Plan reveals that the ongoing drought in northern Kenya is forcing thousands of girls into child marriages — 39% of girls told us they have married early in the last six months, with cases of sexual violence sharply increasing.

Girls and women face the threat of sexual and physical violence as they search for scarce drinking water, often traveling long distances. In conflict settings, girls are sometimes forced to engage in transactional sex for food or money to keep themselves and their families alive.

4. There aren’t enough qualified health care providers

All women have the right to quality care before, during and after giving birth. But for too many, the reality is very different. Approximately 86% of maternal deaths take place in the regions of sub-Saharan Africa and Southern Asia, where access to quality health care and trained health professionals is severely limited.

For many pregnant women, like Prem in northern Laos, the nearest hospital is hours away.

“When I was about to deliver, my mother-in-law and husband tried to support me at home,” Prem says. “I don’t know how long it took, but it felt like it was ages, and it was painful. I could only hear my husband and mother-in-law walking around, shouting at each other … I didn’t know exactly what they were doing. I thought I would die.”

Prem survived, but shortly after giving birth, her daughter stopped breathing. Her husband and mother-in-law didn’t know what to do to save her.

“I couldn’t believe that I lost my daughter at birth, and I couldn’t stop crying for a few days,” Prem says. “It was the wrong decision to deliver my first child at home.”

Now Plan, in partnership with the Laos government, is constructing three new health centers in Prem’s district and equipping them with modern medical equipment. We are also providing training to midwives and health care workers to strengthen their community engagement skills, to ensure more pregnant women can visit health centers whenever they need to.

When we checked in with Prem, she was pregnant again, and plans to deliver her baby in the new health facility.

A nurse at the health center in Laos smiles while taking the blood pressure of a young pregnant woman.
A nurse at the health center monitors Prem’s blood pressure during a prenatal visit.

Accessing quality health care isn’t easy in the U.S. either. In fact, the maternal mortality rate is higher here than in any other high-income country — and the situation is getting worse. After rising slowly for decades, maternal deaths have spiked in recent years, likely due to strained health systems and limited health care access. In 2020, there was a 14% increase compared to 2019, and a 31% increase from 2018.

According to the CDC, four out of five maternal deaths — more than 80% — are preventable. The leading causes of death are mental health conditions, excessive bleeding, heart conditions, infection and blood clots. More than half of deaths occur between seven days and a year after the baby is born, when the well-being of the mother is often neglected. Women in the U.S. are more likely to skip postpartum care due to the cost, compared to women in countries where maternal care is free.

It’s more dangerous to have a baby now than it was 20 years ago, particularly for women of color and those living in rural areas.

According to a recent report, 36% of U.S. counties are located in “maternity care deserts” — geographic areas where the nearest quality maternal health care is hundreds of miles away. And with more rural hospitals closing, more women’s lives are at risk.

Black mothers in the U.S. are three times more likely to die due to childbirth complications than White women, often suffering pregnancy-related death associated with medical racism. Tennis champion Serena Williams recently shared her near-death experience in her own words, detailing how she had to fight to save her own life while pregnant. Her account demonstrates how difficult it can be for Black women to get the care they need, even when you are one of the most famous athletes in the world with financial resources many others do not have.

What can you do to help?

If all of this makes you angry, good. We’re angry too! All women and girls deserve access to quality and affordable health care, as well as the freedom to make their own informed choices about their bodies. Plan is committed to protecting girls’ and women’s sexual and reproductive rights around the globe, including here in the U.S.

One way you can join the fight today is by purchasing Gifts of Hope — real, tangible items needed by the girls and communities where we work. Gifts of Hope are your investments in a more equal future, for girls and for all of us.