After years of steady decline, maternal mortality rates have largely stagnated in recent years, with some parts of the world even seeing increases in maternal deaths, according to a new report from the World Health Organization (WHO) and other United Nations agencies.

Progress on reducing maternal mortality has stagnated

For the report, researchers analyzed maternal mortality data from 185 countries and territories between 2000 and 2020.

In 2020, there were 287,000 maternal deaths worldwide, a slight decrease from roughly 309,000 deaths in 2016. The maternal mortality rate in 2020 was 223 maternal deaths per 100,000 live births, or an average of one pregnancy- or childbirth-related death every two minutes.

According to the researchers, maternal mortality rates declined by an average of 2.7% every year between 2000 and 2015. However, between 2016 and 2020, these rates largely stagnated, with some regions of the world even seeing increa

Separate figures from CDC also show that the maternal mortality rate is even higher for Black women, who are three times more likely to die from pregnancy-related complications than white women. Native American women also faced a significantly higher risk of dying during and after their pregnancy.

In general, maternal mortality rates continue to be highest in the poorest parts of the world, including those facing conflict and disaster. Sub-Saharan Africa has the highest maternal mortality rate of all the regions, accounting for around 70% of all maternal deaths worldwide.

Although the pandemic may have contributed to some of this lack of progress, researchers said the trend was already several years in the making. The true impact of COVID-19 on maternal mortality rates will likely be seen when 2021 data is released.

"While pregnancy should be a time of immense hope and a positive experience for all women, it is tragically still a shockingly dangerous experience for millions around the world who lack access to high quality, respectful health care," said WHO Director-General Tedros Adhanom Ghebreyesus.

What is causing high maternal mortality rates?

The leading causes of maternal mortality include severe bleeding, high blood pressure, infections, complications from unsafe or inaccessible abortions, and other conditions complicated by pregnancy, such as HIV/AIDS and malaria. According to WHO officials, many of these causes are preventable or treatable with access to adequate healthcare.

A lack of investment in primary and maternal care, as well as shortages of both healthcare workers and supplies, can also exacerbate the risk of maternal mortality in certain countries. Currently, around a third of women worldwide do not receive half of the recommended prenatal or postnatal care.

"Maternal deaths increase when women have less access to quality, timely services, particularly around the time of delivery," said Jenny Cresswell, an epidemiologist at WHO and an author of the report. "Anything which creates barriers to that — either for the whole population or for subgroups within a population — can lead to increasing maternal mortality rates."

WHO officials also stressed a need for women to have autonomy over their sexual and reproductive health. Currently, 270 million women lack access to contraception, and almost half of all pregnancies are unplanned.

What can be done to reduce maternal mortality rates?

So far, the world has fallen significantly behind on the United Nations' goal of reducing maternal mortality rates to 70 deaths per 100,000 live births by 2030. If the current trend continues, there could more than 1 million additional maternal deaths by that time.

"The data are a wake-up call for us, to take action to avoid future deaths," said Anshu Banerjee, a WHO assistant director-general.

The report suggested several potential solutions, including strengthening healthcare systems with more workers, ensuring access to sexual and reproductive healthcare services, and investing in women's health and education.

Willibald Zeck, chief of sexual and reproductive health and rights at the United Nations Population Fund, also noted that ensuring equity in external factors, such as economic security and access to education, will help reduce race and class-based health disparities.

In the United States, federal officials and lawmakers are currently making efforts to reduce maternal disparities in the country.

At HHS' Black Health Summit, CMS Administrator Chiquita Brooks-LaSure underscored the importance of health providers, including doulas, midwives, and community health workers, listening to their pregnant patients. Currently, CMS is working with states to ensure that a variety of providers, including those who are "health-adjacent," are part of maternal care teams.

Data collection will also be critical to addressing maternal health issues. CMS is now including maternal health metrics, such as unnecessary C-sections and excessive bleeding at delivery, in the data requirements of its payment rules for hospitals and providers.

The agency has also proposed a new "birthing-friendly" designation for hospitals, making it the first hospital quality designation that specifically focuses on maternal health.

In the House, Rep. Lauren Underwood (D-Ill.), Rep. Alma Adams (D-N.C.), and other members of the Black Maternal Health Caucus are working to pass "The Momnibus," a package of 12 bills focused on addressing clinical and nonclinical factors of maternal health factors.

"We know exactly what to do," Underwood said. "It's evidence-based, we know how much it costs, and when we do these things it doesn't just save Black moms, it helps all moms ... and improves the quality of care for every birthing person in this country." (Joseph, STAT, 2/22; Roy, Reuters, 2/22; Rabin, New York Times, 2/22; McShane, NBC News, 2/22; Firth, Medpage Today, 2/23)