Challenges of reducing maternal mortality

Maternal mortality reduction in Latin America and the Caribbean has slowed down in the last decade, exacerbated by excess maternal deaths, both directly and indirectly associated with the COVID-19 pandemic, which caused a 20-year reversion in the region's maternal health indicators. In the region, one woman dies every hour due to complications during pregnancy, childbirth, and puerperium . A technical report estimates that almost 3,000 maternal deaths could have been averted if the pandemic had not had an impact on the provision of sexual and reproductive health (SRH) services. This is compounded by the decline in private health input procurement, widespread stock-outs, and reduced demand for healthcare.

In this region, one of the most imbalanced in health, maternal deaths are the very embodiment of this inequity in terms of gender, ethnicity, place of residence, education, and socioeconomic status. Pre-pandemic studies point to a higher maternal mortality ratio among indigenous women, a phenomenon that the context of the pandemic, presumably, must have worsened due to overwhelmed health systems, isolation measures, and a decline in the quality of reproductive healthcare services, particularly in rural areas.

Three facts that speak for themselves:

1. Between 2020 and 2021, 93% of maternal deaths associated with COVID-19 occurred among indigenous and Afro-descendant women .
2. A study in Brazil found that ethnically diverse women are 3.5 times more likely to die from pregnancy-related causes than white women .
3. A systematic review of this issue concluded that migrant women are twice as likely to die from pregnancy-related causes .

Not only do women in these populations have their rights to health and life violated but so do their families and communities. Stopping these preventable deaths will significantly impact the development of countries throughout the region.

The World Bank in Latin America and the Caribbean supports initiatives in countries across the region that face the most severe burden of maternal mortality and finances research studies enhancing evidenced-based good practices and cost-effective policies, including Honduras, Haiti, and Guatemala.  For example, Honduras was supported in establishing and implementing the maternal mortality review committees.

Positioning Maternal Health as a Matter of Priority

The commitment of governments and strategic partners is key to addressing the different determinants that impact and ensure the reduction of preventable maternal morbidity and mortality. Sustainable Development Goal (SDG) 3: “To ensure healthy lives and promote well-being for all at all ages”, includes Target: "By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births ".

On the other hand, the Sustainable Health Agenda for the Americas (SHAA), which adapts the global goals to the region, defines the following target: "Reduce the regional maternal mortality ratio (MMR) in Latin America and the Caribbean to less than 30 per 100,000 live births in all population groups"

Based on estimates, the maternal mortality ratio due to the COVID-19 pandemic in 2019 was 77 maternal deaths per 100,000 live births, and in 2020, 88 per 100,000 live births, with preliminary estimates suggesting an even higher ratio in 2021.

Data and cost-effective interventions are available for vigorous action by governments and strategic partners, calling on society to protect women and newborns in the name of development and social justice.

In this context, the Regional Task Force for the Reduction of Maternal Mortality (GTR, by its acronym in Spanish) along with other agencies, including the World Bank and the Pan American Health Organization, launched on March 8th: “Zero Maternal Deaths: Prevent the Preventable” campaign, a high-level initiative to reposition maternal health in Latin America and the Caribbean by 2023.