More than a mother: a deep dive into women’s health and mortality

Women's health has long been defined through the lens of motherhood. Pregnancy and childbirth are some of the most intense and transformative experiences a woman can undergo, and so they have been a major focus of health policy and investment. But the data tells a more complex story.

A success story with limits

Over the past 2 decades, maternal mortality has generally decreased across the WHO European Region (Fig. 1). This is progress: more than 98% of births in the Region occur in a health facility and approximately 99% of births are attended by skilled health personnel. This success can be credited to improved clinical care, better surveillance and sustained political attention.

^{Fig. 1. Deaths from maternal conditions fluctuate but are decreasing in the WHO European Region. Source: WHO}

However, nearly all maternal deaths are avoidable and can be prevented through effective public health interventions or timely, high-quality care. Still, more than 3500 women in the WHO European Region died from maternal causes between 2018 and 2022. In fact, since 2013, maternal mortality rates have stagnated, and in eastern and northern Europe, they have increased.

Beyond maternal mortality

Maternal health receives greater attention, yet the majority of women's deaths occur outside the maternal period. Women are living longer than ever before, but not necessarily in good health. They spend more years than men living with chronic illness and disability.

At the same time, trends in all-cause mortality reveal persistent geographic inequalities. Although mortality rates among women have generally declined across the Region since 2000, a woman's place of residence continues to have a profound influence on her chances of living a long and healthy life. Women in central Asia, eastern Europe and western Asia continue to experience substantially higher mortality rates than those in northern, southern and western Europe. This gap has remained unchanged for more than 2 decades (Fig. 2). This raises a question: if progress is fragile even in the most documented aspects of women's health, what happens in the areas that receive far less attention?

^{Fig. 2. A persistent east-west divide in women's mortality. Source: WHO}

A system shaped by priorities

Health systems and the data behind them reflect societal priorities. This is why policies and interventions often focus on women during their reproductive years. This focus is partially due to demographic concerns, with increasing attention to fertility and population trends. But this emphasis comes with a risk: women are prioritized when they are seen as central to reproduction and overlooked in the decades that precede or follow. The consequences of this imbalance become visible in the data.

Not just how women die, but how we record their deaths

Men have higher mortality rates than women across nearly all major causes of death (Fig. 3).

^{Fig. 3. Male mortality rates are higher than female mortality rates for all top causes of death in ages 45+. Source: WHO}

But when we look more closely, another pattern emerges. Among women 45 and older, deaths are significantly more likely to be recorded in poorly specified categories - classified officially as "ill-defined" causes of death. These include terms such as frailty, cardiac arrest, heart failure, unspecified dementia or simply unknown causes. In fact, women in this age group are around 14% more likely than men to have their cause of death classified as ill-defined (Fig. 4).

^{Fig. 4. Women aged 45+ are proportionally more likely to die from an ill-defined cause than men in the same age group. Source: WHO}

Some of this difference due to ill-defined causes is expected. Women live longer, and older age is often accompanied by multiple chronic conditions, making cause-of-death certification more complex. Still, this is only one part of the explanation. There is growing evidence that women experience delayed diagnosis, are less investigated and remain underrepresented in clinical research, particularly in cardiovascular diseases.

Cardiovascular disease - the leading cause of death for both men and women - often presents differently in women and may be under-recognized. These factors influence not only how women are treated during life, but also how their deaths are recorded.

When deaths are poorly defined, the implications go beyond data quality and begin to obscure the true burden of disease, weaken prevention strategies and distort research priorities. In effect, women become less visible - not only in health systems, but in the data that shape decisions.

The invisible risks

Other risks, like violence, also remain under-recognized. Plotting maternal mortality against mortality from violent causes reveals a contrast (Fig. 5).

^{Fig. 5. Women are more likely to die from violence, than from maternal health conditions. Source: WHO}

At the same time, the available data on violence against women likely underestimate the true scale of the problem. Violence against women is often underreported due to stigma, social norms and legal sensitivities, making it one of the most difficult indicators to measure.

More concerning still is the age distribution. Violence against women is often perceived as a problem affecting younger women, yet the risk does not disappear with age. Older women continue to experience intimate partner violence, psychological abuse and other forms of violence, while the risk of femicide persists throughout the life course.

The persistence of violence into older age highlights a broader challenge in how women's health is understood and addressed. When we define women's health narrowly, we not only overlook the biological and clinical needs of ageing women, but we also fail to recognize the broader risks that shape their later lives.

Older women face a growing burden of chronic disease, disability and dependency, including musculoskeletal disorders, dementia and other neuropsychiatric conditions that can profoundly affect quality of life, functioning and care needs. Yet, these issues often receive far less attention than reproductive and maternal health, despite accounting for the majority of women's years lived with ill health and, ultimately, many of their deaths.

A more inclusive definition of women's health

Closing the health gap between women and men requires more than simply improving health-care delivery. It requires strengthening the data systems that shape how we understand women's health across the life course.

This means improving:

• diagnosis through more inclusive clinical research, greater awareness of sex-specific disease presentation and treatment and more equitable diagnostic practices;
• population health surveillance through better long-term care data, more age- and sex-disaggregated analyses and stronger visibility of older women in health statistics; and
• mortality intelligence through better cause-of-death certification, stronger investigation of deaths at older ages and greater coding specificity.
  

Recommended actions

Immediate investment is needed to accelerate progress towards Sustainable Development Goal 5.2 to eliminate violence against women in all public and private spaces and the implementation of regional level laws and regulations.

Member States of the WHO European Region should:

1. embed violence against women in national health policies and ensure supportive environments;
2. implement health sector policies on violence against women;
3. ensure the availability of essential services, including for post-rape care;
4. remove barriers for survivors to access high-quality, rights-based health care; and
5. develop quality assurance and accountability mechanisms.

Methodology:

The word "women" in this story refers to people assigned as female at birth, and whose sex is recorded as such with their government. As of 2026, the WHO Mortality Database contains data on 3 types of sex, as this is the data WHO receives from Member States: "male", "female" and "undetermined".

The data used in this story was downloaded from the WHO Mortality Database. This database is a compilation of mortality data by country and area, year, sex, age and cause of death, as transmitted annually by national authorities from their civil registration and vital statistics system. Only data with at least 65% completeness are published in the database.

The countries in this piece are part of the WHO European Region, which consists of 53 countries in Europe and parts of Asia. These countries have been grouped in subregions for analytical purposes. The subregions are based on the UN Statistical Office's geographic regions.

Due to differences in data collection and transmission processes, the story is limited to data through 2022, the most recent year for which comprehensive mortality reporting is available for the majority of countries in the Region.

Mortality indicators are not reported by some countries when the recorded number of deaths falls below a specific threshold. This is done to maintain data privacy and prevent the identification of individuals.

Furthermore, Andorra, Monaco and San Marino have been excluded from this analysis as they do not report mortality data to the WHO.

To provide a more accurate reflection of regional trends and mitigate the impact of annual fluctuations, the story utilizes 5-year averages (2018-2022). This approach smooths out statistical outliers, ensuring that the identified challenges represent patterns and trends rather than exceptions.