Integrating family planning and maternity services reduces global maternal mortality

A landmark study published in The Lancet Global Health provides clear evidence that the global decline in maternal deaths over the past two decades has been driven by improvements in both family planning and maternity care. The study, "Effect of maternity care improvement, fertility decline, and contraceptive use on global maternal mortality reduction between 2000-2023: results from a decomposition analysis," by World Health Organisation (WHO) and Human Reproduction Programme (HRP) re-analysed data from 195 countries and territories to examine the relative contributions of maternity care and family planning on global maternal mortality. Overall global maternity mortality declined by 41% between 2000 and 2023.

The researchers examined what would have happened if access to maternity care and family planning had not improved over this period, allowing them to estimate the specific contribution of each factor to the overall decline. We found that 61.2% of the decline in maternal mortality is attributable to improvements in maternity care, while 38.8% stems from fertility reduction. Importantly, increased contraceptive use alone averted an estimated 77 400 maternal deaths in 2023, underscoring the vital, life-saving role of family planning alongside quality clinical care.

The researchers were able to quantify the direct impact of contraception on maternal mortality, separate from maternity care, showing that contraceptive use alone prevented an estimated 77 400 maternal deaths in 2023, representing nearly one quarter of all maternal deaths averted that year. These findings provide compelling new evidence that access to contraception is not only a matter of human rights, choice and empowerment but a proven life-saving intervention. By enabling women to plan and space their pregnancies, contraception helps prevent complications that arise from pregnancies that occur too early, too late or too close together, and reduces the need for unsafe abortions, both major causes of maternal death worldwide.

The study underscores the urgent need to sustain and expand investments in sexual and reproductive health along with maternity care. It shows that progress towards reducing maternal deaths can be achieved by concerted efforts to improve maternity care and increasing contraceptive use; countries must also address unmet need for family planning and ensure that women can plan their pregnancies safely. The study notes that achieving the Sustainable Development Goal 3.1 target, to reduce the global maternal mortality ratio to fewer than 70 deaths per 100 000 live births by 2030, will require integrating family planning and maternity care more effectively, especially in low-income settings where contraceptive prevalence remains low.

"This study is for policy-makers and service providers, to inform health systems everywhere. It shows that access to contraception and quality maternity care are not just health interventions - they are fundamental to saving lives and advancing gender equality. We must ensure that every woman, everywhere, has the means to plan her family and access the care she needs for preventing unintended pregnancy and for a safe pregnancy and childbirth."

- Pascale Allotey, Director, HRP and WHO's Department of Sexual, Reproductive, Maternal, Child, Adolescent Health and Ageing (SRMCAHA).

By quantifying the combined contributions of maternity care and contraceptive use, this research offers a powerful and timely message: continued investment in family planning and maternal health is essential to saving lives and accelerating global progress on maternal survival.