Although maternal mortality rates are down sharply from where they were 20 years ago, a recent United Nations report shows the world’s progress toward reaching the UN’s sustainable development goal of reducing maternal mortality has stalled. Further, there is evidence that rates may be heading in the wrong direction. In 2020, the global maternal mortality ratio was 152 deaths per 100,000 live births, up from 151 deaths per 100,000 live births the year before.
Results from the Year 2 Hologic Global Women’s Health Index, conducted in 2021, suggest that many women also see the care where they live beginning to slip when it comes to providing pregnant women with high-quality prenatal healthcare. The majority of women surveyed in Year 2 (65%) said they think most pregnant women in their city or area receive high-quality healthcare during their pregnancies, down slightly from the 69% who said so in Year 1 (conducted in 2020).
The Year 3 report, which will be available in 2023, will provide further insights into whether this decline continued in 2022.
While maternal mortality rates are much higher in low-income economies than high-income economies -- illustrating the prioritization, resourcing and funding challenges behind the problem -- women in all country income groups were less likely in Year 2 than Year 1 to believe pregnant women in their area receive high-quality prenatal care.
On average, 81% of women in high-income economies believe they have access to high-quality prenatal care, down three percentage points from Year 1 -- as do 50% of women in low-income economies, down nine points from Year 1, which qualifies as a significant change.
The Best and Worst Countries and Territories for Perceived Quality Prenatal Healthcare
Women in Northern European countries such as Finland and Norway and countries in Western and Central Europe such as France, the Netherlands and Switzerland were the most likely in the world to believe most pregnant women in their communities get high-quality care, with at least 90% of women reporting this.
These countries with the highest perceptions of prenatal care among women have low maternal mortality rates, high GDP per capita and large investments in the health of their population, as demonstrated by their high health expenditures per capita.
Meanwhile, the countries with the lowest perceptions of quality prenatal care among women include low-income to upper-middle-income countries situated all along the spectrum of maternal mortality rates.
From Year 1 to Year 2, perceptions of the quality of prenatal care dropped most among women in high-income (Hong Kong, Hungary, Lithuania and Uruguay) and upper-middle-income (Serbia, Romania, Georgia and Jamaica) economies.
Real-world conditions at the time could have contributed to these declines. For example, the measures taken to curtail the spread of the COVID-19 pandemic severely disrupted healthcare systems around the world. Many countries had to restrict access to care and treatment, which directly affected people’s healthcare experiences, including those of pregnant women. Suddenly, because of the risk of infection transmission, it became more complicated to have regular face-to-face interactions with healthcare professionals or have partners attend appointments.
In addition, in some countries, shocks such as internal political conflicts may have worsened the situation. For instance, Myanmar has been contending with a shortage of doctors and the closing of healthcare facilities since the military coup in February 2021. In Hong Kong, civil unrest has disrupted the healthcare system.
Conversely, some countries that showed a significant year-over-year increase have taken intentional steps to improve care for pregnant women. For instance, in Nicaragua, where perceptions improved by 13 points, maternity waiting homes providing care before childbirth are available in rural communities far from hospitals. As of 2021, the network included 178 homes.
In Zimbabwe -- where perceptions of prenatal care improved among women by 14 points -- a voucher program offering affordable care to low-income women who cannot afford required copays has been available for years.
Many Men Unaware of Women’s Healthcare Experiences
Women in Year 2 continued to evaluate the quality of prenatal care slightly higher than men did, with 65% of women and 61% of men agreeing that women in their communities receive high-quality care. Yet, there is more to the story.
Many men answered that they do not know whether pregnant women get high-quality prenatal care. Globally, one in nine men (11%) said they do not know or could not say -- but these percentages are more substantial in some countries and rise to the majority level in a few countries, such as Latvia (53%) and Lithuania (51%).
Implications
The quality of care a woman receives is still intrinsically tied to where she lives. However, simply surviving pregnancy and childbirth shouldn’t be the only marker of success for pregnant women. Improving access to and delivery of high-quality prenatal care is key to ending preventable maternal deaths.
Despite progress made around the world, pregnant women’s lives remain at risk. Where sociopolitical settings are in chaos and health systems falter, women are telling us how these institutions are failing them.
Women should not fear death as they give life, and reducing the maternal mortality ratio should be a priority on the global development agenda. Mothers are the backbone of societies, and their children carry the future of our economies. Given the evidence of backsliding, it is time for policymakers and leaders to rethink how they can more effectively protect pregnant women and girls through strategic investments in maternal health.
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