Aid cuts could have ‘pandemic-like effects’ on maternal deaths, WHO warns

(The Guardian) More women risk dying in pregnancy and childbirth because of aid cuts by wealthy countries, which could have “pandemic-like effects”, UN agencies have warned.

Pregnant women in conflict zones are the most vulnerable, and face an “alarmingly high” risk that is already five times greater than elsewhere, according to a new UN report on trends in maternal mortality.

Deaths due to complications in pregnancy and childbirth declined 40% globally between 2000 and 2023, but progress is “fragile” and has slowed since 2016, the authors said. An estimated 260,000 women died in 2023 from pregnancy-related causes.

There is a “threat of major backsliding” amid “increasing headwinds”, the authors said. US funding cuts this year have meant clinics closing and health workers losing their jobs, and disrupted the supply chains that deliver life-saving medicines to treat leading causes of maternal death such as haemorrhage, pre-eclampsia and malaria, World Health Organization experts warned.

The report – itself part-funded by the US – revealed that maternal deaths rose by 40,000 in 2021 due to the Covid pandemic, probably driven by complications from the virus itself and by the disruptions to healthcare.

Dr Bruce Aylward, an assistant director general at the WHO, said that rise could offer insights into the possible impact of current aid cuts.

“With Covid, we saw an acute shock to the system, and what’s happening with financing is an acute shock,” he said.

“Countries have not had time to put in place and plan for what other financing they’re going to use, what other workers they’re going to use, [and] what are the trade-offs they’re going to make in their systems to try to make sure the most essential services can continue.”

The shock to services, he said, would lead to “pandemic-like effects”, adding that funding cuts risked not only progress, “but you could have a shift backwards”.

Deaths around the world would need to fall 10 times faster than at present – by 15% rather than 1.5% a year – to achieve the sustainable development goal target of less than 70 per 100,000 live births before 2030.

The report highlighted significant inequalities. In poor countries in 2023, there were 346 maternal deaths per 100,000 live births – nearly 35 times the 10 per 100,000 in rich countries. While in high- and upper middle-income countries, 99% of births are attended by a health professional, this falls to 73% in poor countries.

Countries where there are conflicts, or which are characterised as “fragile”, accounted for 61% of global maternal deaths, but only 25% of global live births.

A 15-year-old girl in a poor country has a one in 66 chance of dying from a pregnancy or childbirth-related cause. In a rich country, the figure is one in 7,933 – and in a country at war the figure is one in 51.

Catherine Russell, Unicef’s director, said: “Global funding cuts to health services are putting more pregnant women at risk, especially in the most fragile settings, by limiting their access to essential care during pregnancy and the support they need when giving birth.

“The world must urgently invest in midwives, nurses and community health workers to ensure every mother and baby has a chance to survive and thrive.”

Maternal mortality rates have “stagnated” in many parts of the world since 2015, the report found, including northern Africa and much of Asia, Europe, North and Latin America, and the Caribbean.

The authors called for further efforts to ensure critical services were maintained and to improve access to family-planning services and education.

Pascale Allotey, director of the WHO’s reproductive health department, said: “It is an indictment on our humanity and a real travesty of justice that women die in childbirth today.

“It really is something that we all have a collective responsibility for,” she said. “We have to step up.”