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Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio
        
  
    
    
      
     
 Caring for mothers
          
     More than 500,000 women die each year in childbirth, most of them in developing countries. What makes maternal mortality such a compelling problem is that it strikes young women experiencing a natural function of life. They die because they are poor. Malnourished. Weakened by disease. Exposed to multiple pregnancies. And they die because they lack access to trained health care workers and modern medical facilities.

     Death in childbirth is a rare event in rich countries, where there are typically fewer than 15 maternal deaths for every 100,000 live births. But in the poorest countries of Africa and Asia the ratio may be 100 times higher. And because women in poor countries have more children, their lifetime risk of maternal death may be more than 200 times greater than for women in Western Europe and North America.
    
      
     

        
 Mothers at risk in Africa and South Asia 
Left axis (line): total fertility rate (births per woman); right axis (bar): maternal mortality ratio (deaths per 100,000 live births)
       

     Maternal mortality ratios are still unacceptably high in many developing countries as a result of high fertility rates and a high risk of dying each time a woman becomes pregnant.
    
Sub-Saharan Africa South Asia
    

     Some developing countries have improved maternal health significantly through better services in hospitals and increased numbers of trained birth attendants and midwives.
    
East Asia & Pacific Latin America & Caribbean

 
    

     Still others not only improved maternal health, but significantly lowered fertility rates directly through use of contraceptives and indirectly through increased female education.
    
Europe & Central Asia Middle East & North Africa
                  

Source: World Bank staff estimates.
                  

    
 Mothers die because of inadequate health care
Causes of maternal death, 2000 (%)
    

a. Includes anemia, malaria, and heart disease.
b. Includes ectopic pregnancy, embolism, and anesthesia-related deaths.
Source: AbouZahr 2003.
     

     Maternal deaths are difficult to measure because they are relatively rare events and because reporting systems are least adequate in the countries with the highest levels of mortality. Deaths may go unreported or their connection to pregnancy or childbirth may go unnoted. When a maternal death is reported, the cause of death may not be known. Recent estimates of major obstetric complications based on aggregate data suggest that severe bleeding after delivery is the leading cause of maternal deaths. As with many complications of childbirth, skilled personnel and modern medical facilities are needed to treat such cases and save the lives of mothers.
              

        
 Needed: well trained health workers
Share of births attended by skilled health personnel, most recent year, 2000–02 (%)
              

a. Available data represent 40 percent of the population.
Source: World Bank staff estimates from data compiled by WHO and UNICEF.
                 

     Women are most in need of skilled care during and immediately after delivery, when most maternal deaths occur. The single most critical intervention is to ensure that a competent health worker with midwifery skills is present at every birth and that transport is available to a referral facility.

     Apart from Sub-Saharan Africa and South Asia, delivery care has improved significantly in developing regions, though not all countries have shared equally in such improvements. About half the births in developing countries are not assisted by a skilled health worker.
             

             
 Poor and rural women are least well served
Share of births attended by skilled health personnel, by family wealth quintile and location (%)
                 

Health care during childbirth varies considerably. Births to women in the richest quintile are six times more likely on average to be attended by a trained professional such as a doctor, nurse, or midwife.
Bangladesh, 1999-2000
 
                 

Urban-rural differences are greatest when overall use of health care professionals is low, as in Bangladesh, Cambodia, and Guatemala, where 40 percent or fewer births are attended by skilled personnel.
Cambodia, 2000
 
                  

Urban women are more likely to have access to doctors, nurses, and medically trained midwives and to hospital facilities equipped to deal with obstetric emergencies.
Guatemala, 1998-99
 
                  

Poor quality services and limited access are major causes of maternal illness and death. Investment in infrastructure (roads, communication facilities) is needed, along with more skilled health workers.
South Africa, 1998

 

Source: World Bank staff estimates based on Demographic and Health Survey data.
           

Mothers at risk in Africa and South Asia
Sub-Saharan Africa
South Asia
East Asia & Pacific
Latin America & Caribbean
Europe & Central Asia
Middle East & North Africa
   
Mothers die because of inadequate health care

               

Needed: well trained health workers

           
Poor and rural women are least well servedBangladesh, 1999-2000
Cambodia, 2000
Guatemala, 1998-99
South Africa, 1998