From 1990 to 2010, the number of maternal deaths worldwide dropped from more than 540,000 to less than 290,000 – a decline of 47%. While substantial progress has been achieved in almost all regions, many countries, particularly in sub-Saharan Africa, will fail to reach the Millennium Development Goal (MDG) 5 target of reducing maternal mortality by 75% from 1990 to 2015.

One-third of all maternal deaths occur in two countries – in 2010, almost 20% of deaths (56,000) were in India, and 14% (40,000) were in Nigeria. Of the 40 countries with the world’s highest rates of maternal mortality, 36 are in sub-Saharan Africa.

Many low-income countries continue to be burdened by high rates of maternal mortality and high fertility, which are closely linked to high infant mortality and gender inequality. More than 1/4 of girls and women in sub-Saharan Africa cannot access family planning services, fueling unplanned pregnancies and spreading HIV and other sexually transmitted diseases.

Ensuring access to quality reproductive health and family planning services is fundamental to human development results and is a top priority in the Bank’s 2007 Healthy Development strategy.

Under its five-year Reproductive Health Action Plan (2010-15), the Bank is helping 57 low-income countries with high maternal death and fertility rates improve their reproductive health services and help ensure that women and children survive and can live healthy, productive lives. Specifically, Bank projects work to increase access to family planning services, increase skilled attendance at births, train health care workers, and expand girls’ education.

As a result of the Action Plan, the proportion of World Bank Country Assistance Strategies and projects that address reproductive health in high burden countries is increasing; more than half of all ongoing Bank health projects include reproductive health components or indicators/70 percent of all ongoing projects in high maternal mortality and/or high fertility countries include a reproductive health focus. For example:

  • In Bangladesh, the Health Sector Development Project is strengthening delivery of reproductive, maternal, and child health services, including providing more skilled-birth attendants and improving the nutrition of pregnant women and children;
  • In Mozambique, the World Bank is scaling up access and utilization of maternal and child health and nutrition services through community based interventions;
  • In Swaziland, the World Bank is training doctors and midwives in antenatal, emergency obstetrics, and neonatal and postnatal care, and is improving access to specialized facilities; and
  • In Yemen, the Health and Population Project is increasing poor women’s access to and use of maternal and child health services, especially in remote and rural areas.

During the past decade from 2003 to 2013, IDA the International Development Association (IDA), the World Bank’s fund for the poorest countries has:

  • provided more than 117 million people with access to basic packages of health, nutrition, or reproductive health services;
  • trained more than 2.6 million health personnel
  • constructed, renovated, and/or equipped more than 10,000 health facilities;
  • immunized nearly 600 million children;
  • provided more than 194 million pregnant women with antenatal care during a visit to a health care provider;
  • ensured that more than 29 million births were attended by skilled health personnel;
  • ensured that more than 210 million pregnant/lactating women, adolescent girls, and/or children under age five were reached by basic nutrition services;
  • purchased and/or distributed more than 149 million long-lasting, insecticide-treated malaria bed nets;
  • purchased and/or distributed more than 386 million condoms;
  • provided more than 7.6 million people with tuberculosis treatment according to WHO DOTS recommendations;
  • ensured that more than 1.3 million adults and children received antiretroviral combination therapy.

Countries have also reported remarkable results:

  • Afghanistan reported a 22% reduction in infant mortality and 26% reduction in child mortality in three years.
  • Benin: 2 million medicated bed nets benefited pregnant women and children under age five from 2007-2011.
  • Georgia reported a 29% increase in health insurance coverage for poor women of reproductive age and a 59% increase in coverage for children under age five.
  • Ghana: Improved maternal and child health care reduced mortality rates for children under five to 80 per 1,000 live births in 2008, from 111 in 2003.
  • Lesotho: Prevention of mother-to-child HIV transmission rose from 5% in 2005 to 31% in 2009. The country reported a 10% increase in contraceptive prevalence rate from 2004-2009.
  • Burkina Faso: Contraceptive prevalence has more than doubled, from 15% to 33%, and assisted deliveries have increased from 67% to 82% between 2010 and 2013.