Goal 5Figures published c. 2005 by the World Bank. The Millennium Development Goals program concluded in 2015; this site is preserved as a historical record.
Women in high-fertility countries in sub-Saharan Africa have a 1-in-16 lifetime risk of dying from maternal causes, compared with women in low-fertility countries in Europe, who have a 1-in-2,000 risk, and in North America, who have a 1-in-3,500 risk. In many countries, high maternal mortality rates result from inadequate reproductive health care for women and inadequately spaced births.
The United Nations aims to reduce maternal mortality around the world. Its Millennium Development Goals set a maternal mortality target in 2001, numbered target 6 at the time and renumbered target 5.A when the framework was revised in 2008. It asked for a three-quarters reduction in the maternal mortality ratio, the number of maternal deaths per 100,000 live births, between 1990 and 2015. In 2015, the UN adopted the Sustainable Development Goals and updated that threshold to no more than 70 deaths per 100,000 live births by the year 2030.
The high rates of maternal mortality throughout much of the developing world reflect a systemic neglect of women’s reproductive health, particularly for the poorest women, from prevention to intervention.
Even where fertility rates are low, the timing and spacing of pregnancies, as well as the extent to which births are wanted, warrant attention. Greater access to family planning can help reduce the maternal mortality rate by reducing the number of pregnancies.
In addition to contraception, women need access to a broader range of services. The primary means of preventing maternal deaths is rapid patient access to emergency obstetrical care, including treatment of hemorrhages, infections, hypertension, and obstructed labor. It is also important to ensure that a midwife or doctor is present at every delivery. In developing countries, only about half of deliveries are attended by professional medical staff, reflecting uneven skilled birth attendance indicators.
Skilled attendants must be supported by the right environment. Life-saving interventions, such as antibiotics, surgery, and transportation to medical centers, are unavailable to many women, especially in rural areas. These women may lack the money for health care and transport, and in some cases they lack their husbands’ permission to seek care.
This page covers MDG target 5.A and what it achieved, together with the SDG target that replaced it. It also covers regional data through the skilled birth attendance indicator and explains what the semaglutide and tirzepatide labels say about pregnancy.
Scope: this page describes population-level indicators and health policy. It is educational reference material, not medical advice, and gives no guidance for any individual’s health decisions.
Lifetime risks of dying from pregnancy or childbirth
The lifetime risk of maternal death measures the probability of a woman, starting from age 15, dying from pregnancy or childbirth in her reproductive lifetime, to about age 49.
A 1-in-3,000 lifetime risk represents a low risk of dying from pregnancy or childbirth, while a 1-in-100 lifetime risk is a high risk of dying.
Where these risks differ among women often falls along regional, economic, and educational lines.
Change in the proportion of attended birth in the last 10 years
All regions except for the Middle East and North Africa appear to have fallen short of achieving the 2015 target. Only 56% of women in developing countries give birth with the assistance of a trained midwife or doctor. In Latin America, where the share of births attended by skilled health personnel is high, maternal mortality is relatively low. But in Africa, where skilled attendants and health facilities are not readily available, it is very high.
Fertility rates
Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with prevailing age-specific fertility rates. Fertility rates are highest in sub-Saharan Africa. Rates across most of Europe and East Asia sit below the replacement rate of about 2.1 births per woman.
What MDG target 5.A achieved, and where it fell short
Target 5.A asked for a three-quarters reduction in the maternal mortality ratio between 1990 and 2015. The final assessment, published in November 2015 by WHO, UNICEF, UNFPA, the World Bank Group, and the UN Population Division, put the global ratio at 216 maternal deaths per 100,000 live births in 2015, against 385 in 1990. An estimated 532,000 women died of maternal causes in 1990. The 2015 estimate was 303,000, a reduction of 43%.
That is a fall of about 44%, short of the target 75%.
Nine countries met the three-quarters reduction: Bhutan, Cabo Verde, Cambodia, Iran, the Lao People’s Democratic Republic, Maldives, Mongolia, Rwanda, and Timor-Leste. Developing regions accounted for about 99% of maternal deaths in 2015, and sub-Saharan Africa for about 66% on its own.
| Year | Maternal mortality ratio | Maternal deaths |
|---|---|---|
| 1990 | 385 per 100,000 live births | 532,000 |
| 2015 | 216 per 100,000 live births | 303,000 |
| 2023 | 197 per 100,000 live births | 260,000 |
Tirzepatide and pregnancy: what the label says
The World Health Organization counted 2.5 billion overweight adults in 2022, including 890 million adults living with obesity. A national case-control study in France, published in the International Journal of Obesity, found that severe obesity more than tripled the risk of maternal death. The study defined severe obesity as a body mass index of 35 or higher. Class 1 obesity roughly doubled the risk.
Obesity during pregnancy is also associated with higher risks of gestational diabetes, gestational hypertension, pre-eclampsia, cesarean delivery, and stillbirth. The effect of GLP-1 medicines on these trends remains uncertain. KFF’s 2025 poll found that about one in eight US adults were currently taking a GLP-1 medicine.
Tirzepatide (Mounjaro, Zepbound) is a GIP and GLP-1 receptor agonist. Mounjaro is indicated for adults and children 10 years and older with type 2 diabetes. Zepbound is indicated with diet and physical activity for long-term weight reduction in adults with obesity or overweight plus a weight-related condition. Zepbound is also indicated for moderate to severe obstructive sleep apnea in adults with obesity.
The labels carry reproductive guidance that matters for people who could become pregnant. No MDG or SDG indicator tracks whether women taking these medicines receive that guidance. The available human data on tirzepatide in pregnancy are insufficient to evaluate risks of major birth defects, miscarriage, or other adverse maternal or fetal outcomes.
Semaglutide: stop two months before planned pregnancy
Semaglutide is sold as Ozempic and Wegovy. Its United States prescribing information says to discontinue it at least two months before a planned pregnancy because of its long washout period.
Tirzepatide and pregnancy: discontinue when pregnancy is recognized
The Zepbound label advises that weight loss is not recommended during pregnancy because it offers no benefit to a pregnant patient and may cause fetal harm. It advises patients to discontinue Zepbound when pregnancy is recognized.
The Mounjaro label states that available data are insufficient and that animal reproduction studies indicate potential fetal risks. It says Mounjaro should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Zepbound also has a pregnancy exposure registry. Pregnant patients exposed to Zepbound, and their health care providers, are encouraged to register by calling 1-844-524-0039 or emailing [email protected]. To learn more, visit https://pregnancyregistry.lilly.com/zepbound.
The label carries a separate warning for people using oral hormonal birth control. Tirzepatide may reduce its effectiveness because it delays gastric emptying. The delay is largest after the first dose and diminishes over time. The label advises switching to a nonoral contraceptive method or adding a barrier method. Continue it for four weeks after starting tirzepatide and for four weeks after each dose increase. Nonoral hormonal contraceptives are not affected.
Can you take tirzepatide while pregnant?
The Zepbound label advises discontinuing it when pregnancy is recognized. The Mounjaro label says to use tirzepatide during pregnancy only if the potential benefit justifies the potential risk to the fetus. Anyone who is pregnant or planning a pregnancy should discuss tirzepatide with the prescriber. People taking Mounjaro for diabetes should promptly discuss a pregnancy treatment plan with their prescriber, because poorly controlled diabetes also poses risks to the pregnant patient and fetus. This page summarizes prescribing labels and does not give medical advice.
How long before pregnancy should you stop semaglutide?
Stop semaglutide at least two months before a planned pregnancy, according to United States prescribing information. This is semaglutide guidance, not a tirzepatide washout rule.
Does tirzepatide affect birth control?
Yes. Tirzepatide may reduce the effectiveness of oral hormonal contraceptives. Use a nonoral method or add a barrier method for four weeks after starting treatment and for four weeks after each dose increase. Nonoral hormonal contraceptives are not affected. See also the double burden of malnutrition and noncommunicable diseases and SDG target 3.4.
Sources: Mounjaro prescribing information, sections 1, 8.1, and 8.3; Zepbound prescribing information, sections 1, 8.1, and 8.3; FDA prescribing information for semaglutide (Ozempic), section 8.3; WHO, Obesity and overweight fact sheet. Checked August 2026.
Regional maternal death rates
WHO estimates about 260,000 maternal deaths in 2023, a global ratio of 197 per 100,000 live births. That is more than 700 deaths a day, or one about every two minutes. Around 92% occurred in low-income and lower-middle-income countries.
The concentration is regional as well as economic. Sub-Saharan Africa accounted for around 70% of the 2023 total, about 182,000 deaths. Southern Asia accounted for around 17%, about 43,000. Together the two regions carry about 87% of maternal deaths worldwide.
| Setting | Maternal mortality ratio, 2023 |
|---|---|
| Low-income countries | 346 per 100,000 live births |
| High-income countries | 10 per 100,000 live births |
| Conflict-affected settings | 504 per 100,000 live births |
| Fragile settings | 368 per 100,000 live births |
| Neither conflict-affected nor fragile | 99 per 100,000 live births |
Conflict concentrates the risk further. In 2023, 37 countries classified as conflict-affected or as institutionally and socially fragile accounted for 61% of global maternal deaths while producing 25% of global live births.
Lifetime risk states the same inequality for one person rather than one year. WHO defines it as the probability that a 15-year-old will eventually die of a maternal cause. In low-income countries it is 1 in 66. In high-income countries it is 1 in 7,933.
Despite persistently high maternal death in some parts of the world, the UN’s development goals have made real progress elsewhere. In central and southern Asia, the lifetime risk fell 83% between 2000 and 2023, from 1 in 71 to 1 in 410. Sub-Saharan Africa cut its ratio by 40% over the same period but still records the highest ratio of any region.
What the skilled attendance indicator counts
The proportion of births attended by skilled health personnel was MDG indicator 17. It carries into the SDG framework as indicator 3.1.2. It records whether a trained midwife, doctor, or nurse was present at the birth.
Coverage reflects income closely. In most high-income and upper-middle-income countries, about 99% of births have a skilled attendant present. The figure is 84% in lower-middle-income countries and 73% in low-income countries.
Numbers can be misleading because presence is not always a guarantee of capability. The indicator records that a qualified person attended. It does not record whether the facility could supply blood, antibiotics, a working operating theater, or a referral route, and those inputs decide the outcome of a severe hemorrhage or an eclamptic seizure. Five causes account for about 75% of maternal deaths:
- Severe bleeding, mostly after childbirth
- Infections, mostly after childbirth
- High blood pressure during pregnancy, including pre-eclampsia and eclampsia
- Complications arising from delivery
- Unsafe abortion
Maternal deaths rose from an estimated 282,000 in 2020 to 322,000 in 2021 during the COVID-19 pandemic. Both the ratio and the count fell again in 2022, so the interruption to the downward trend was short-lived.
SDG target 3.1 replaced MDG target 5.A
MDG target 5.A expired in 2015 when the updated SDG target 3.1 replaced it. Target 3.1 asks countries to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030, with no country recording more than twice the global average.
The global ratio in 2023 was 197. Reaching 70 by 2030 requires an annual reduction of almost 15%, a rate that has rarely been sustained at national level. Between 2000 and 2023 the global ratio fell about 40% in total.
Sources
- World Health Organization, Maternal mortality fact sheet. Figures for 2023.
- WHO, UNICEF, UNFPA, World Bank Group and the UN Population Division, Trends in Maternal Mortality: 1990 to 2015, November 2015.
- US Food and Drug Administration, Ozempic (semaglutide) prescribing information, section 8.3.
- US Food and Drug Administration, Mounjaro (tirzepatide) prescribing information, sections 8.1 and 8.3.
- World Health Organization, Obesity and overweight fact sheet.
- Saucedo, M., Esteves-Pereira, A. P., Pencolé, L., Rigouzzo, A., Proust, A., Bouvier-Colle, M. H., and the CNEMM Study Group, Understanding maternal mortality in women with obesity and the role of care they receive: a national case-control study, International Journal of Obesity, volume 45, issue 1.
- KFF, Poll: 1 in 8 Adults Say They Are Currently Taking a GLP-1 Drug for Weight Loss, Diabetes or Another Condition, Even as Half Say the Drugs Are Difficult to Afford.
- Development Goals website (developmentgoals.org), Maternal Health page (archived copy), last updated September 2003 with data from World Development Indicators 2003 (World Bank). The introductory paragraphs on this page are adapted from that original page.
developmentgoals.org documents these statistics and cites the agencies that produce them. It does not produce them.