Maternal mortality remains a major public health challenge in Africa, despite global efforts to address it. The World Health Organization (WHO) defines maternal mortality as the death of a woman during pregnancy or within 42 days of termination of pregnancy due to causes related to pregnancy or its management, excluding accidental or incidental causes (WHO, 2023).
Although maternal mortality has declined globally over the past few decades, disparities persist between developed and developing regions. In 2015, an estimated 303,000 women died due to pregnancy-related complications, with 99% of these deaths occurring in low-resource settings (WHO, 2023). Sub-Saharan Africa alone accounted for 70% of all maternal deaths in 2020, with an estimated maternal mortality ratio (MMR) of 531 deaths per 100,000 live births (United Nations Population Fund [UNFPA], 2023).
This article analyzes maternal mortality trends across Africa’s five regions (North, East, Central, South, and West Africa), highlighting disparities, contributing factors, and potential strategies for achieving global maternal health targets.
Global and Regional Maternal Mortality Trends
Overall Trends in Africa
Between 2000 and 2017, the maternal mortality ratio (MMR) in Africa declined from 718 to 442 deaths per 100,000 live births, representing a 38.5% reduction (WHO, 2023). However, progress has been uneven, with some regions achieving faster declines than others. A join point regression analysis identified key trends:
- 2000–2003: Moderate reduction (-2.4% annual percent change (APC)).
- 2003–2008: Accelerated decline (-3.9% APC).
- 2008–2015: Slower reduction (-2.7% APC), likely influenced by the 2007–2008 global economic crisis.
- 2015–2017: Further slowdown (-1.3% APC) (UNFPA, 2023).
Maternal Mortality by African Region
1. North Africa
North Africa has consistently reported the lowest maternal mortality rates in Africa.
- MMR decreased from 122.58 to 75.09 deaths per 100,000 live births (2000–2017).
- The annual reduction rate was -2.8%, with notable declines between 2000–2007 (-3.5% per year), followed by a slower decline from 2007–2014 (-1.2% per year), before improving to -1.9% per year from 2014–2017 (WHO, 2023).
- North Africa is closest to achieving the Sustainable Development Goal (SDG) target of an MMR below 70 per 100,000 live births (UNICEF, 2023).
2. East Africa
East Africa has shown substantial progress, recording the second-largest reduction in maternal mortality.
- MMR fell from 853 to 443 deaths per 100,000 live births (a 48.07% reduction).
- The region had a -4.3% annual reduction, with major joinpoints in 2004, 2009, and 2015 (WHO, 2023).
- Despite this progress, MMR disparities remain high among East African countries (UNFPA, 2023).
3. Central Africa
Central Africa experienced a 35.84% reduction in maternal mortality.
- MMR declined from 798.35 to 512.19 deaths per 100,000 live births (2000–2017).
- The annual decline rate (-2.7%) slowed to -2.0% from 2011–2014, indicating stagnation in progress (Integrated African Health Observatory [iAHO], 2023).
4. Southern Africa
Southern Africa recorded the most significant reduction in MMR.
- MMR decreased from 468 to 218 deaths per 100,000 live births (a 53.42% reduction).
- The annual reduction rate was -4.8%, with notable improvements from 2007–2013 (-6.0% per year), indicating resilience to economic crises (WHO, 2023).
5. West Africa
West Africa started with the highest MMR and remains the highest-risk region.
- MMR dropped from 982 to 708 deaths per 100,000 live births, a 27.90% reduction.
- The region experienced a -2.0% annual decline, significantly slower than other regions (iAHO, 2023).
- West Africa requires greater intervention efforts to meet the 2030 SDG maternal health targets (WHO, 2023).
Factors Influencing Maternal Mortality Trends in Africa
1. Access to Healthcare Services
- Antenatal Care (ANC): While Southern Africa had near-universal ANC coverage by 2010, West Africa lagged, with one-third of pregnant women lacking ANC access (WHO, 2023).
- Skilled Birth Attendance: The goal is to achieve 90% SBA coverage by 2025, but Sub-Saharan Africa remains at 73% (UNICEF, 2023).
2. Socioeconomic Determinants
- Education: Low maternal education levels correlate with higher MMR (Anyamele et al., 2017).
- Poverty: Economic disparities force women to deliver at home or in under-resourced health centers (Mkoka et al., 2014).
- Maternal Age: Younger (under 18) and older (over 35) mothers face higher pregnancy complications, particularly in West and Central Africa (Tessema et al., 2017).
3. Conflict and Instability
- Fragile states report MMRs exceeding 551 per 100,000 live births, more than double the world average (Onambele et al., 2022).
Strategies for Reducing Maternal Mortality in Africa
- Strengthening Healthcare Systems: Investment in infrastructure, medical personnel, and essential supplies is critical (WHO, 2023).
- Expanding Access to Maternal Healthcare: Ensuring universal antenatal care, skilled birth attendance, and emergency obstetric care (WHO, 2023).
- Promoting Family Planning: Increasing contraceptive availability can prevent unintended pregnancies and reduce maternal deaths (UNFPA, 2023).
- Developing Maternity Waiting Homes: Encouraging women in rural areas to stay in health facilities before labor (UNICEF, 2023).
- Engaging Communities: Mass education through SMS reminders, community health centers, and partnerships with traditional birth attendants can improve maternal outcomes (iAHO, 2023).
Conclusion
Maternal mortality in Africa remains a pressing challenge, with wide regional disparities. While Southern and North Africa have made significant progress, West and Central Africa require intensified efforts to meet global maternal health goals. Addressing maternal mortality requires multisectoral approaches, increased funding, and systemic healthcare improvements. A commitment to universal maternal healthcare access will be essential to achieving the Sustainable Development Goal (SDG) target of reducing MMR to fewer than 70 deaths per 100,000 live births by 2030.
References
- Anyamele, O. D., Ukawuilulu, J. O., & Akanegbu, B. N. (2017). The role of wealth and mother’s education in infant and child mortality in 26 Sub-Saharan African countries. Social Indicators Research, 130(3), 1125-1146.
- Integrated African Health Observatory (2023). Maternal mortality in Africa: Regional trends and challenges.
- Onambele, L., et al. (2022). Maternal Mortality in Africa: Regional Trends (2000–2017). International Journal of Environmental Research and Public Health, 19(20), 13146.
- United Nations Population Fund (2023). Maternal mortality: Progress and remaining challenges.
- World Health Organization (2023). Maternal Mortality Overview.
