Global maternal mortality ratios: Trends and strategic approaches to making an impact

Global maternal mortality declined by 40% between 2000 and 2023, with the maternal mortality ratio (MMR) falling to 197 per 100,000 live births. In 2023, an estimated 263,000 maternal deaths occurred, 92% due to preventable causes. Despite progress, major disparities persist: 70% of these deaths occurred in sub-Saharan Africa and 17% in Asia, with eight of nine countries with a very high MMR located in sub-Saharan Africa. Leading causes include hemorrhage, cardiac disease, hypertensive disorders, sepsis, embolism, and unsafe abortion. High fertility and limited access to quality care contribute to the disproportionate burden. Maternal death reviews highlight the importance of the postpartum “fourth trimester.” Expanding skilled birth attendance and strengthening facility-based care have proven effective, though progress was hindered by COVID-19 and conflict. Sustained improvement requires prioritizing maternal health, implementing context-specific interventions, and reinforcing accountability.