Maternal mortality across Africa has dropped significantly over the past two decades, with new figures from a United Nations-led report calling it one of the most meaningful public health achievements since records began.
According to a joint study by the World Health Organization and several UN agencies, Africa’s maternal mortality ratio declined from 748 per 100,000 live births in 2000 to 454 in 2023 — equivalent to about 3 million fewer deaths over that 23-year period.
The WHO attributes this decline to growing access to trained birth professionals, better health infrastructure, and targeted interventions in handling pregnancy-related complications.
Major investment in sexual and reproductive health has also played a crucial role, with wider implementation of the WHO’s Ending Preventable Maternal Mortality (EPMM) framework contributing to these improvements.
Notably, skilled attendance at birth has risen to 65% — up from just 44% in 2000 — a development the report credits as a key driver of the decline in fatal outcomes from haemorrhage and infection, the two leading causes of maternal death.
The report also highlights the importance of political will and stronger referral networks, which have enabled more women to access care that can make the difference between life and death.
Still, UNICEF’s Executive Director Catherine Russell has cautioned that reductions in global health funding, especially from the United States, threaten to roll back some of these hard-fought gains — particularly in fragile or underserved regions.
“Slashing global health budgets risks pushing more women into danger during pregnancy and childbirth, especially where basic care is already scarce,” she said.
Regionally, East Africa has made the biggest leap, slashing maternal deaths by over 60%, from 75,000 in 2000 to 42,000 by 2023 — an annual drop of 4.8%, thanks to wider access and policy support in countries such as Kenya and Ethiopia.
North Africa follows with a 57.9% drop, cutting deaths from 11,000 to 5,900 — largely due to improved prenatal services. Central Africa tells a more complex story: while its maternal mortality ratio fell by 43.2%, overall deaths rose from 32,000 to 34,000, a result of population growth outpacing health improvements.
In Southern Africa, maternal mortality declined by 31.5%, but the relatively slow annual progress rate of 2.6% underscores persistent rural healthcare gaps.
West Africa remains a key area of concern. Despite a 25.3% reduction in the ratio, the region still registered a rise in total maternal deaths — reaching 102,000 in 2023, the highest on the continent — as countries like Nigeria and Ghana continue to grapple with overstretched health systems.
Globally, 2023 saw more than 260,000 women lose their lives due to pregnancy-related complications — an average of 712 deaths per day, or one every two minutes. This equates to a global maternal mortality ratio of 197 per 100,000 live births, across 195 nations.
HIV-related maternal deaths, which once represented a significant burden, have also declined dramatically. Thanks to broader access to antiretroviral treatment and integrated prenatal care, such deaths have dropped by 89% since 2000 and now make up less than 1% of maternal deaths in the region. Countries like Eswatini and Botswana, which embedded HIV services into maternal health systems, saw some of the sharpest declines.
Nonetheless, Africa remains the hardest-hit region, accounting for nearly 70% of maternal deaths globally — approximately 182,000 in 2023 — followed by Southern Asia, with around 17% (43,000 deaths).
The progress remains uneven. Nine countries — including South Sudan, Chad, and Nigeria — continue to record extremely high maternal mortality ratios, exceeding 500 deaths per 100,000 births.
Nigeria stands out with an MMR of 993 and accounts for nearly 29% of all maternal deaths on the continent. This points to a combination of structural weaknesses in healthcare, insecurity, and persistent cultural barriers.
“While progress is evident in several regions, fragile contexts and conflict zones continue to reverse hard-won gains,” the report cautions.
Countries labelled as fragile or conflict-affected by the World Bank — such as Somalia and the Democratic Republic of Congo — showed slower improvements. In some of these countries, women face a 1 in 51 lifetime risk of dying from pregnancy-related causes, more than twice the global average.
The pandemic also disrupted maternal health services temporarily, with global MMR rising in 2021. Africa, however, managed to restore its pre-COVID trajectory by 2022, a feat credited to quick recovery of prenatal and postnatal services.
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