Let’s reflect on Global Maternal Health
Alex Burner
As doulas we often think locally, we’re concerned about the statistics of the Trusts in our local area or we’re concerned about welfare of the woman or birthing person we’re working with at the time. But I want us to take a moment, in light of the WHO World Health Day 2025, to reflect on global maternal health inequalities.
Whilst the overall maternal mortality rates globally are falling there remain massive disparities in your chances of surviving childbirth determined by where you’re giving birth.
The maternal mortality rate in the UK is 13.56 in 100,000, or 0.13% (slightly higher than 5 years ago, and the highest of all Western European countries - compare this to 4 per 100,000 or 0.004% in Germany), the maternal mortality rate in Nigeria is a staggering 993 per 100,000, 0.99%. It is the most dangerous place to give birth in the world.
Given the current collapse of the health system in Gaza due to the genocide taking place I wonder about the maternal mortality rates in conflict-affected countries and territories across the globe. Back in 2023 when the WHO released “Trends in Maternal Mortality 2000 - 2023” the maternal mortality rate in conflict-affected countries and territories was 504 per 100,000, 0.5%. I can only imagine as the violence in Gaza, Sudan, Yemen and other areas draws on these rate will once again rise in 2025.
Each and every one of these deaths is tragic and has long term consequences for the children and families they leave behind. However the WHO report highlights some interesting issues that need addressing and pertain equally to the UK and to Nigeria - despite the massive disparities in maternal deaths. It should also be noted that maternal mortality in Nigeria is actually falling whilst it’s rising in the UK.
Postpartum haemorrhage is the leading cause of maternal death globally, and was highlighted in the MBRRACE Report 2023 as one of the leading causes of maternal death in the UK.
Strengthening maternal health services to include non communicable disease care during pregnancy, birth and the postnatal period - namely improving care for women with chronic conditions and improving the availability and deliverability of mental heath service. Which would benefit the UK hugely as suicide continues to be the leading cause of death for birthing people within the first 6 weeks postpartum.
Tackling social determinants of maternal mortality - namely race, ethnicity, gender identity and educational attainment. (Always remember reading at Uni that they halved maternal mortality in Bangladesh back in the 90’s by upping the number of women taught to read - must find the reference somewhere! And yet in Afghanistan women have lost access to education in 2025 - and have one of the highest maternal mortality rates globally.) We know that systemic racism within the maternity system in the UK continues to disadvantage Black and Asian women who have 3 times the mortality rate of white women in the UK.
Harmful gender norms, biases and inequalities. It makes headlines regularly these days that women are struggling to access timely diagnosis and treatment in the UK. We know for recent research that gender identity negatively impacts how you access healthcare here in the UK and how that healthcare is then delivered, “because the healthcare of vulnerable groups is often neglected as a result of deep rooted inequalities”.
These are all issues that are at the forefront of those calling for change to how our maternity system delivers care during pregnancy, birth and the postpartum period. Combined with lack of funding and inadequate staffing it would appear we have a long way to go before we will see a reduction in global maternal mortality rates and a reduction in the rates of maternal mortality in the UK.