Maternal Mortality Reduction in Sub-Saharan Africa: Progress, Challenges, and Strategies

Maternal mortality, defined as the death of a woman during pregnancy, childbirth, or within 42 days of termination of pregnancy, remains a major public health challenge in Sub-Saharan Africa (SSA). Despite global efforts, SSA continues to bear the highest burden, accounting for approximately 70% of all maternal deaths worldwide (United Nations, 2024). While progress has been made, significant challenges remain in achieving the Sustainable Development Goal (SDG) 3.1, which aims to reduce the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births by 2030 (United Nations, 2024).

This article explores the progress made, key challenges, and strategic interventions needed to accelerate the reduction of maternal mortality in Sub-Saharan Africa.

Progress in Reducing Maternal Mortality

The introduction of the Millennium Development Goals (MDGs) in 2000 played a crucial role in focusing global attention on maternal health. The global MMR declined from 400 deaths per 100,000 live births in 1990 to 210 per 100,000 live births in 2010 (WHO, 2021). However, SSA experienced a slower decline, with the MMR decreasing from 718 deaths per 100,000 live births in 2000 to 531 in 2020 (European Journal of Midwifery, 2021).

Several countries have made significant progress:

  • Sierra Leone reduced maternal mortality by nearly 60% (2017-2020).
  • Tanzania and Eswatini saw reductions of 55% and 45%, respectively.
  • Between 2000 and 2017, the MMR in Africa declined by 38% (United Nations, 2024).

Despite these achievements, SSA still faces the highest maternal mortality rates globally, with some regions even experiencing stagnation or an increase in MMR (United Nations, 2024).

Key Challenges to Reducing Maternal Mortality

1. Limited Access to Quality Healthcare

Many pregnant women in SSA lack access to skilled birth attendants, antenatal care, and emergency obstetric services. Only 73% of births in the region are attended by skilled personnel, compared to 96% in Eastern and South-Eastern Asia (United Nations, 2024).

2. The “Three Delays” Model

Women face three critical delays that contribute to maternal mortality (Akinokun, 2021):

  1. Delay in seeking care due to lack of awareness, cultural beliefs, and financial constraints.
  2. Delay in reaching a healthcare facility due to poor transportation and long distances.
  3. Delay in receiving appropriate care due to shortages of trained personnel, drugs, and medical equipment.
3. Socioeconomic and Cultural Barriers
  • Poverty: Nearly 46% of SSA’s population lives on less than $1 per day, limiting access to healthcare (United Nations, 2024).
  • Education and Gender Inequality: Women with higher education levels are more likely to seek antenatal care and skilled delivery services (WHO, 2021).
  • Teenage Pregnancies: Early pregnancies increase the risk of maternal complications, with one in four SSA women giving birth before age 18 (Akinokun, 2021).
4. Inadequate Health Systems and Infrastructure
  • Shortage of Healthcare Workers: There are 76 doctors per 100,000 people in SSA, with even fewer trained in maternal health (United Nations, 2024).
  • Poor Facilities: Many health centers lack essential drugs, emergency obstetric care, and surgical services (Akinokun, 2021).
5. Conflict and Humanitarian Crises

Political instability, displacement, and fragile healthcare systems worsen maternal health outcomes. In high-alert fragile states, the average MMR is 551 per 100,000 live births, double the world average (United Nations, 2024).

Strategies for Reducing Maternal Mortality in SSA

1. Improving Access to Skilled Birth Attendants

Training midwives, nurses, and community health workers is critical. Countries with higher skilled birth attendance have lower MMRs (Akinokun, 2021).

2. Strengthening Emergency Obstetric Care (EmOC)
  • Equipping healthcare facilities with life-saving medicines, blood transfusion services, and emergency surgical equipment (Akinokun, 2021).
  • Developing referral systems to ensure timely transfer of high-risk pregnancies to better-equipped hospitals (Akinokun, 2021).
3. Expanding Antenatal Care (ANC) Services

Ensuring that all pregnant women have at least four ANC visits is crucial for detecting and managing complications early (United Nations, 2024).

4. Promoting Family Planning and Contraceptive Use
  • Increased use of modern contraceptives reduces unintended pregnancies and unsafe abortions (United Nations, 2024).
  • Community outreach programs can improve contraceptive uptake, especially in rural areas (Akinokun, 2021).
5. Addressing Social and Economic Determinants
  • Improving education for girls to delay early pregnancies and promote informed healthcare decisions (WHO, 2021).
  • Economic empowerment programs to improve household incomes and healthcare access (United Nations, 2024).
6. Strengthening Health Systems and Infrastructure
  • Increasing government health expenditure to support maternal health services (United Nations, 2024).
  • Investing in digital health solutions (e.g., mobile health messaging for pregnant women) to improve access to maternal care information (Akinokun, 2021).
7. Community Engagement and Awareness Campaigns

Educating women, families, and communities on maternal health risks, danger signs in pregnancy, and available healthcare services (Akinokun, 2021).

8. Maternal Death Surveillance and Response (MDSR)

Establishing strong data collection and reporting systems to identify causes of maternal deaths and develop targeted interventions (United Nations, 2024).

9. Strengthening Partnerships and Global Collaboration
  • Governments, NGOs, and international organizations must work together to implement sustainable maternal health programs.
  • Programs like Smiles for Mothers (Kenya & Nigeria) and CLEVER Maternity Care (South Africa) have proven effective in reducing maternal deaths (Akinokun, 2021).

Conclusion

Maternal mortality remains a critical public health challenge in Sub-Saharan Africa, with poverty, weak health systems, and inadequate access to care as major contributing factors.

However, significant progress can be achieved through increased investment in healthcare, skilled birth attendance, emergency obstetric care, and family planning services.

By scaling up proven interventions, engaging communities, and strengthening partnerships, SSA can move closer to achieving SDG 3.1 and ensuring that no woman dies from preventable pregnancy-related causes.

References

  • Akinokun, R. T. (2021). Reducing maternal mortality in Sub-Saharan Africa through emergency obstetric care. European Journal of Midwifery, 5(September), 39. Retrieved from https://doi.org/10.18332/ejm/140130
  • Eghieye IU Thesis (2014): Maternal Mortality in Sub-Saharan Africa​

World Health Organization (WHO), United Nations (UN), and Maternal Health Reports

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