Maegan Ashworth Dirac, MD, PhD, discusses slowed global maternal mortality progress

Global progress on reducing maternal mortality has slowed markedly during the early Sustainable Development Goal (SDG) period, with 104 of 204 countries and territories yet to meet the SDG 3.1 target (maternal mortality ratio (MMR) of fewer than 70 deaths per 100,000 livebirths), according to a systematic analysis published in The Lancet Obstetrics, Gynaecology, & Women's Health.¹

Drawn from the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, the analysis estimated 240,000 total maternal deaths globally in 2023, equating to a global MMR of 190.5 deaths per 100,000 livebirths. While that represents a substantial decline from 321.0 in 1990, most countries and territories (120 of 204) had slower or reversed annualized rates of change in MMR during 2015 to 2023 compared with the 2000 to 2015 period.

Maegan Ashworth Dirac, MD, PhD, senior author and Assistant Professor of Health Metrics Sciences and Family Medicine, characterized the trajectory as one of diminishing momentum in this interview with Contemporary OB/GYN.

“We do continue to see, at the global total level, improvement in the maternal mortality ratio, but very subtle, following a period of very rapid improvement,” she said. “If we drill down into specific locations, that reflects some particular countries continuing to undergo strong improvements, others sort of flattening, and some loss of previous gains in some countries where we have the greatest burden.”

Where gains are concentrated

Ashworth Dirac noted that countries achieving the largest reductions fell into 2 categories: those with broad development gains and those making targeted maternal care investments.

“In other places we have seen really big improvements in countries that have not had as much sweeping improvement but have made very specific investments in maternal care, both increasing coverage and also quality of the services provided to mothers, and in particular improving the quality of what health facilities have to offer when women access labor and delivery care,” she said.

How does the US fit into the trend?

Addressing rising MMR in the United States, Ashworth Dirac cautioned that reporting changes account for part of the observed trend.

“We know that there were changes to how the national vital statistics were reported prior to 2007 and then after 2016, and so we definitely have some trend that is due to changes in reporting,” she said. Even after correcting for those changes, however, a genuine increase remains. “We still see an increase over the last couple of decades, just not as pronounced a rise and fall as the data suggests, as reported before making corrections.”

She emphasized that US mortality, while concerning, is not the primary driver of the global slowdown, which is concentrated in Sub-Saharan Africa and South Asia, where MMR and the share of global births are highest.

The authors note that pandemic effects are difficult to estimate where timely, high-quality data are scarce, a key limitation of the analysis.

Reference:

GBD 2023 Maternal Mortality Collaborators. Global, regional, and national trends in maternal mortality, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet Obstet Gynaecol Womens Health. 2026. https://www.thelancet.com/journals/lanogw/article/PIIS3050-5038(26)00047-6/fulltext