Five countries — including India — account for 36% of global maternal deaths, a new Lancet analysis finds
India recorded 24,700 deaths in 2023, second only to Nigeria
Global maternal mortality has declined since 1990 but remains far above SDG targets
Most countries are off track, with deaths concentrated in sub-Saharan Africa and South Asia
Haemorrhage and high blood pressure remain leading causes, highlighting gaps in care
Just five countries — Nigeria, India, Ethiopia, Pakistan and Cameroon — account for 36 per cent of maternal deaths worldwide, according to a new analysis published in The Lancet. In other words, more than one in three maternal deaths occur in these nations alone.
The findings, published in The Lancet Obstetrics, Gynaecology, and Women’s Health, highlight the continued concentration of maternal mortality in a small number of countries.
The burden of maternal mortality remains concentrated in sub-Saharan Africa and South Asia, the study found. India recorded 24,700 maternal deaths in 2023, the second-highest globally after Nigeria, which reported 32,900 deaths.
Worldwide, an estimated 240,000 women died from maternal causes in 2023, corresponding to a maternal mortality ratio (MMR) of 190.5 per 100,000 live births.
This represents a decline of more than one-third from 321 in 1990, and a moderate reduction from 280,000 deaths in 2015, when the United Nations-mandated Sustainable Development Goals (SDG) were adopted.
However, the current level remains nearly three times higher than the SDG target of fewer than 70 deaths per 100,000 live births by 2030. The analysis, part of the Global Burden of Disease (GBD) 2023 study covering 204 countries and territories, finds that 104 countries are still off track to meet this target.
Achieving the target will require urgent and focused action, particularly in high-burden regions, the analysis says.
Despite years of progress, Sub-Saharan Africa continues to be the epicentre for maternal mortality, accounting for the majority of high-burden countries and 15 of the 20 countries with the highest maternal deaths. Progress in these regions will be critical to meeting global SDG targets.
Of the 104 countries yet to meet the target, 15 have an MMR between 70 and 100, 16 fall in the range of 100 to 140, and 73 report an MMR above 140. The report also highlights inequalities within countries, noting that even where national averages meet the target, regional disparities persist.
India has made significant progress in reducing maternal mortality, with its MMR falling from 508 in 1990 to 116 in 2023.
Despite this, the country remains above the SDG threshold and off track to meet the 2030 goal.
Given its large population and high absolute number of deaths, India continues to be a critical global hotspot. The study suggests that maternal deaths would need to be reduced by more than half within the next five years to meet the target.
Globally, haemorrhage and hypertensive disorders together account for more than 40 per cent of maternal deaths.
There have been improvements over time, with deaths due to haemorrhage declining to 21.7 per cent in 2023 from 36.1 per cent in 1990, reflecting better emergency care. However, deaths linked to high blood pressure during pregnancy have increased, rising from 16.6 per cent to 20.1 per cent over the same period.
In India, these two causes account for an even larger share, over 45 per cent of maternal deaths. While deaths due to haemorrhage have declined from 45 per cent in 1990 to 33.7 per cent in 2023, they remain a leading cause.
At the same time, deaths related to hypertensive disorders have increased to 12.1 per cent from 10 per cent.
Another area of concern is the rise in late maternal deaths — those occurring between 43 days and one year after childbirth — which have more than doubled globally, from 1.3 per cent to 3.2 per cent in 2023.
This underscores critical gaps in postnatal care and the need to extend medical attention beyond the immediate postpartum period.
The findings highlight persistent inequalities in access to quality maternal healthcare.
Weak primary healthcare systems, gaps in emergency obstetric care and limited postnatal follow-up continue to put women at risk. In many cases, data gaps also make it harder to track progress and ensure accountability.
The COVID-19 pandemic further disrupted healthcare services, contributing to an increase in maternal deaths in 2020 and 2021.
The study calls for urgent and targeted action, particularly in high-burden regions.
Strengthening emergency obstetric care, improving primary healthcare systems and extending postnatal care beyond the current six-week window are seen as critical steps. Addressing leading causes such as haemorrhage and hypertensive disorders, alongside better data systems, will also be essential.
Building more resilient health systems capable of withstanding future crises, including pandemics, will be key to sustaining progress in reducing maternal mortality, the analysis says.