Worldwide, more than a quarter of a million women died during their pregnancy or within six weeks of giving birth in 2023, WHO figures reveal, while in the United States, a separate study has found more than a third of these deaths occur more than six weeks after childbirth, when most new mothers think they are in the clear.
Globally, the WHO data reveal, a woman dies every two minutes due to failures in maternal healthcare, prompting fresh warnings about the impact of health funding cuts on women around the world.
The WHO report shows there were 260 000 maternal deaths in 2023, equating to 712 women a day or 30 per hour – most of them in sub-Saharan Africa.
The agency has warned that the global target for all UN member states to reduce maternal deaths down to 71 per 100 000 by 2030 will be missed by more than twice this amount as “the pace of progress has slowed to a near standstill”.
Leading health organisations, including the WHO, say the recent sweeping cuts to international aid by the US Government – more than $770m for maternal health and family planning – risks a reversal of the progress made on slashing maternal deaths, defined as any death related to or aggravated by pregnancy, or within six weeks of the end of a pregnancy.
Dr Bruce Aylward, assistant director-general of universal health coverage for the WHO, said: “The funding cuts risk us taking a backwards step.” He said that cuts were already affecting access to lifesaving supplies and medicines, and especially treatments for some of the leading causes of maternal death.
“One of the first things being seeing already is that countries are laying off staff, or not hiring, or they’re slowing down that health-worker spend… This is a real concern,” he added.
The Independent reports that around 60 countries worldwide depend on US-funded maternal care programmes and family planning services, largely concentrated in Africa and South Asia.
These also provide funding for midwives in areas where essential maternal care is lacking.
But it’s not just the US: aid cuts are happening around the world.
In February, British Prime Minister Sir Keir Starmer announced that the government would slash its aid spending from 0.5% of national income to 0.3% in 2027 – a cut of about £6bn – to pay for increased defence spending in the country.
The announcement came after the government’s International Development Committee (IDC) warned that UK aid cuts have already had a devastating impact on women and girls, with young girls in Sudan more likely to die during pregnancy than finish school.
Sub-Saharan Africa, India, highest death rates
The new WHO figures reveal that one in 36 girls aged 15 in West Africa are at risk of maternal death. This compares to one in 16 000 across southern Europe.
Since 2000, global maternal mortality rates have declined by 40%, from 328 per 100 000 live births to 197 in 2023. However, the figures reveal inequalities across high- and low-income countries.
Dr Pascale Allotey, director of the Department of Sexual and Reproductive Health at the WHO, warned: “Despite advances since 2000, the pace of progress has slowed to a near standstill. In some regions, we are already sliding backwards. In this context of fragility, complacency is not just dangerous, it is deadly … When women die because of where they live, what they earn, or what rights are denied, it is indefensible, and it is preventable.”
According to the report, half of all maternal deaths in 2023 were recorded in Nigeria, India, the Democratic Republic of the Congo and Pakistan. Nigeria alone accounted for one in three deaths, with around 75 000 deaths in 2023, while 70% of deaths occurred in sub-Saharan Africa.
The world’s key international organisation focused on women’s reproductive health, the United Nations Population Fund (UNFPA), has also warned that the US funding cuts to aid will risk an increase in maternal death rates.
Estimates by UNFPA show that $92m of US aid is distributed in Nigeria, where death rates are highest. UNPFA itself has lost $330m in grants from the cuts to USAID.
Julia Bunting, programme director for UNFPA, said while there has been progress in reducing maternal deaths globally, it is “by no means fast enough”. She said: “We know there has been a 40% decline in maternal death rates since 2000, but … the progress is uneven and slowing.”
Although UNFPA has faced cuts to its funding from USAID, Monica Ferro, director of the organisation’s London representation office, confirmed that it has yet to have its funding cut by the UK, which is its second-biggest donor.
However, she warned: “The combination of funding cuts, the increasing frequency of conflicts and the impacts of climate change mean pregnant women can’t access lifesaving care, and gender-based violence is rising. We can’t abandon the women and girls who need us most.”
A state department spokesperson said that the American Government has provided longstanding support to lifesaving maternal and child health services in lower-income countries where most – more than 90% – of all maternal and child deaths occur.
Deaths in America
But in the United States itself, there’s alarm at the soaring rate of maternal deaths within the country, which have risen over the past several years – according to the recent national study.
During a recent five-year period, a substantial portion of maternal deaths in the US – almost one-third – took place more than six weeks after childbirth, at a time when most new mothers think they are in the clear, the researchers reported.
Their study, one of the first to track maternal health complications during pregnancy and in the year after delivery, found that the rates of pregnancy-related death in the US increased by nearly 28% between 2018 and 2022, with large disparities based on state, race, and ethnicity.
Published in JAMA Network Open, the research had analysed four years of nationwide data from the US Centre for Disease Control & Prevention’s division of reproductive health, which monitors maternal mortality and identified the risk of so-called later maternal deaths – those that occur from six weeks to one year after the birth.
The Trump administration shuttered the division recently, even though the United States has far higher maternal mortality rates than any other industrialised nation, with stark disparities among racial and ethnic groups.
The division’s research aimed at understanding and narrowing those health gaps.
The study team found that there were 6 283 pregnancy-related deaths during that time, and that the rate increased from 25.3 pregnancy-related deaths per 100 000 live births in 2018 to a peak of 44.1 in 2021, before dropping slightly to 32.6 in 2022.
TIME Magazine reports that the increase occurred across all of the age groups the researchers analysed, but women aged 25 to 39 experienced the highest increase.
The researchers noted that the pandemic could have had an impact on maternal health and the healthcare system at large, particularly in 2021.
Dr Rose Molina, one of the study’s authors and an ob-gyn at Beth Israel Deaconess Medical Centre, said she and her colleagues observed “a large variation by state” in the rates of pregnancy-related death, and the disparities could be related to variation in access to prenatal, labour and delivery, and postpartum care, as well as in state Medicaid coverage, she added.
“But there really shouldn’t be this level of variation across the states, and we need to do better,” she said.
The study also found that the pregnancy-related death rate was 3.8 times higher among American Indian and Alaska Native women than among white women. Similarly, the rate was 2.8 times higher among non-Hispanic black women than it was among white women.
Molina said many other studies had found that variations in access based on income or geography, as well as biases in the healthcare system, can all contribute to racial and ethnic inequities in maternal health outcomes.
The study found that, overall, cardiovascular disease was the leading cause of pregnancy-related deaths. Cancer, mental and behaviour disorders, and drug or alcohol-induced death were contributing factors to late maternal death.
Because the US has the highest maternal mortality rate among high-income nations, Molina told The New York Times, the study “illustrates why we cannot take our eyes off of maternal health”.
“Women need access to high-quality care from the moment of conception to a full year after birth,” she added. While there has been a growing emphasis on care in the year after childbirth, “we’re not there yet”.
The risks facing women in the first year after a delivery were not well understood until recently.
They take their toll after what traditionally is the new mother’s last recommended checkup, six weeks after childbirth – a period when attention is focused primarily on the health of the new baby.
The American College of Obstetricians and Gynaecologists now recommends that all women see a doctor within the first three weeks after birth, with follow-up and ongoing care as needed, and a comprehensive postpartum visit no later than 12 weeks after birth.
“If you have any hypertensive disorders, I’m going to see you three to five days after delivery,” Dr Tamika Auguste, the chair of women’s and infants’ services at MedStar Washington Hospital Centre and an author of the new guidelines.
“No longer are we saying, ‘Let’s wait six weeks’,” she added. “Anyone else, even without hypertension, I want to see within two weeks.” Patients should also be screened carefully for depression and mental health issues during that period.
Study details
Pregnancy-Related Deaths in the US, 2018-2022
Yingxi Chen, Meredith Shiels, Tarsicio Uribe-Leitz et al
Published in JAMA Network Open on 9 April 2025
Abstract
Importance
The US has the highest rate of pregancy-related death among high-income countries, and disparities continue to widen despite many of these deaths being largely preventable.
Objective
To examine the age-standardised national rates of pregnancy-related death from 2018 to 2022 in the US, stratified by cause, and to compare the rates across state and race and ethnicity.
Design, Setting, and Participants
This serial cross-sectional study used nationwide data on births and pregnancy-related deaths from the Centres for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research. All pregnancy-related deaths among women aged 15 to 54 years from 2018 to 2022 were included.
Exposure
State, race and ethnicity, and age.
Main Outcomes and Measures
The primary outcomes were all-cause and cause-specific maternal death and late maternal death (ie, deaths occurring >42 days and up to 1 year after pregnancy). The age-standardised annual and aggregated rate of pregnancy-related mortality (ASR) was estimated by age group and race and ethnicity, and state-specific crude pregnancy-related mortality rates per 100 000 live births and 95% CIs were calculated.
Results
During 2018 to 2022, there were 6283 pregnancy-related deaths, including 1891 late maternal deaths. The ASR increased by 27.7% from 25.3 deaths per 100 000 live births (95% CI, 23.7-26.9) in 2018 to 32.6 deaths per 100 000 live births (95% CI, 31.2-34.8) in 2022. The increase was observed across age group and was disproportionately driven by deaths that occurred among women aged 25 to 39 years (by 36.8%, 2018 vs 2022). There was a considerable variation in rates by state, ranging from 18.5 to 59.7 deaths per 100 000 live births. If the national rate was reduced to the lowest state rate, 2679 pregnancy-related deaths could have been prevented in 2018 to 2022. American Indian and Alaska Native women had the highest ASR (106.3 deaths per 100 000 live births), followed by non-Hispanic Black women (76.9 deaths per 100 000 live births). Although cardiovascular disease was the leading cause of the overall pregnancy-related deaths, cancer, mental and behaviour disorders, and drug-induced and alcohol-induced death were important contributing causes of late maternal death.
Conclusions and Relevance
In this cross-sectional analysis of pregnancy-related deaths in the US, rates increased during 2018 to 2022, with large variations by state and race and ethnicity. The concerning rates in the US should be an urgent public health priority.
WHO Trends in Mortality Report (Open access)
JAMA Network Open article – Pregnancy-Related Deaths in the US, 2018-2022 (Open access)
TIME Magazine article – Pregnancy-Related U.S. Death Rates Have Jumped in Recent Years (Open access)
The New York Times article (Restricted access)
See more from MedicalBrief archives:
American College of Obstetricians and Gynaecologists
A woman dies every two minutes in pregnancy or childbirth: UN report
Pandemic linked to substantially worse pregnancy outcomes worldwide