Women’s chances of surviving childbirth improved significantly during the MDG era. After 1990, the global maternal mortality ratio (MMR: maternal deaths per 100000 live births) fell by about 44%, with progress accelerating after 2000.13, 14 However, global progress fell far short of the 75% reduction target set by MDG 5a.15 The death toll remains high – in 2015, an estimated 303000 women died from preventable causes during pregnancy and childbirth, with a global MMR of 216 deaths per 100000 live births. Ninety-nine per cent of all maternal deaths still occur in low- and middle-income countries, with more than 50% in sub-Saharan Africa and almost one third in South Asia.16, 17 The SDG target is a global ratio of less than 70 deaths per 100000 live births by 2030.18
The most frequent causes of maternal death are postpartum haemorrhage, hypertensive disorders, infection and complications from childbirth and abortion (Figure 3). Although abortion is safe when performed in accordance with recommended guidelines, many women undergo unsafe procedures. Nearly 7 million women in developing countries are treated for complications from unsafe abortions annually.19
Other women die from the interaction between pregnancy and pre-existing health conditions that could have been addressed and managed during pregnancy, for example communicable diseases such as HIV/AIDS, tuberculosis and malaria, and noncommunicable diseases such as cardiovascular diseases. Millions more suffer complications from pregnancy that continue after childbirth. The list of such morbidities is long and diverse, and includes infection, obstetric fistula and depression.20
Additionally, in 2015, there were an estimated 2.6 million stillbirths: 18.4 for every 1000 births. The Every Newborn Action Plan target is 12 or fewer stillbirths per 1000 births in every country by 2030.21 Half of the stillbirths occurred during labour and birth, mostly from preventable conditions, and mostly in low- and middle-income countries.22 There are huge inequities. At the present rate of change, it will be 160 years before a pregnant woman in Africa has the same chance of carrying her pregnancy through to a live birth as a woman in a high-income country.23 Stillbirth rate is one of the 16 key indicators to be monitored for the EWEC Global Strategy. However, being absent from the MDGs and still missing from the SDGs, stillbirth has received relatively little attention.