A MAJOR new analysis reveals that improvements in maternity care were the dominant force behind the 41% drop in global maternal deaths between 2000 and 2023. The study examined trends in 195 countries and found that while fewer pregnancies played an important role, the largest gains came from safer childbirth, expanded obstetric care, and stronger health systems.
Researchers analysed data from the Maternal Mortality Estimation Inter-Agency Group and the UN’s World Contraceptive Use 2024 database. Using decomposition and counterfactual modelling, the team quantified how much of the reduction in maternal deaths could be attributed to better maternity care, reduced fertility rates, and increased contraceptive use.
Maternal Mortality Declines Driven by Improved Care and Family Planning
The study found that improved maternity care accounted for 61.2% of the overall decline in maternal mortality. Fertility reduction contributed 38.8%, reflecting fewer lifetime pregnancies and reduced exposure to pregnancy-related risk. Contraception emerged as a major driver: rising contraceptive prevalence in low- and middle-income countries is estimated to have prevented 77,400 maternal deaths in 2023 alone, roughly one quarter of all deaths that would otherwise have occurred.
Regional patterns varied. Fertility reduction had the largest effect in Latin America and the Caribbean, sub-Saharan Africa, and eastern and southeastern Asia, regions where demographic transitions have advanced rapidly. But the authors caution that absolute maternal mortality remains unacceptably high in many settings, and progress has slowed or stalled in recent years.
Improving Services and Expanding Contraception Key to Accelerating Progress
The analysis underscores the dual strategy needed to accelerate progress: continue scaling high-quality maternity care, including skilled birth attendance, emergency obstetric services, and timely referral systems, while expanding access to modern contraception and family planning services. The authors argue that the global community must sustain investment in both areas if the Sustainable Development Goal target of fewer than 70 maternal deaths per 100,000 live births is to be achieved.
Reference
Ahmed S et al. Effect of maternity care improvement, fertility decline, and contraceptive use on global maternal mortality reduction between 2000 and 2023: results from a decomposition analysis. Lancet Glob Health. 2025;DOI:10.1016/S2214-109X(25)00409-7.
