Nearly two-thirds of all maternal deaths worldwide occur in countries affected by conflict or fragility, making pregnancy significantly more dangerous in unstable environments, according to a new report by the World Health Organization (WHO) and partners.
The report found that women living in conflict-affected countries face a risk of dying from maternal causes that is about five times higher per pregnancy than women in stable nations.
In 2023 alone, an estimated 160,000 women died from preventable maternal causes in fragile and conflict-affected settings — accounting for six in 10 maternal deaths globally — despite those countries representing only about one in 10 live births worldwide.
The technical brief, produced by WHO alongside the United Nations Development Programme (UNDP), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), and the World Bank, analysed why maternal mortality remains disproportionately high in crisis-affected settings.
It confirmed that conflict and instability create conditions where health systems are unable to consistently provide life-saving maternal care. The report also highlighted how gender, ethnicity, age and migration status intersect to increase risks for pregnant women and girls in fragile contexts.
The disparity is stark: a 15-year-old girl living in a conflict-affected country in 2023 had a one in 51 lifetime risk of dying from a maternal cause. This compares with a one in 79 risk in institutionally and socially fragile countries, and one in 593 in relatively stable countries.
According to the report, countries classified as conflict-affected recorded an estimated maternal mortality ratio of 504 deaths per 100,000 live births. Institutionally and socially fragile countries had a ratio of 368, while countries outside both categories recorded a much lower ratio of 99.
The findings build on last year’s maternal mortality estimates for 2000–2023, which showed that global progress has stalled and maternal mortality remains alarmingly high in low-income and crisis-affected settings.
The publication also presented case studies demonstrating how frontline teams are working to sustain maternal health services amid instability.
In Ethiopia, practical measures such as deploying mobile health teams, renovating facilities and recruiting additional midwives have helped restore disrupted services and ensure continuity of care.
In Haiti, efforts have focused on removing cost and infrastructure barriers, including providing free or low-cost caesarean sections and ensuring reliable electricity supply to make life-saving care accessible to displaced women.
By linking maternal mortality data to fragility classifications, WHO and its partners say they now have a more precise tool to identify where health system strengthening is most urgently needed.
The brief emphasised the need to invest in primary healthcare, improve data collection in hard-to-reach settings, and design resilient health systems capable of absorbing and adapting to shocks.
According to the UN health agency, sustained efforts in these areas can accelerate progress in reducing preventable maternal deaths — even in the world’s most challenging environments.