Every day in 2020, almost 800 women died from preventable causes related to pregnancy and childbirth. Most of these complications develop during pregnancy and are preventable or treatable (WHO, 2024[1]). Some countries in the Asia Pacific region face challenges such as limited access to affordable, high-quality public healthcare, gender norms that restrict women’s movements, and sociodemographic factors impeding the delivery of maternal health services. Additionally, the region is significantly affected by high fertility rates, early marriage, and teenage pregnancies (ADB, 2024[2]).
Maternal mortality ratio (MMR) averaged around 121 deaths per 100 000 live births in lower-middle- and low-income Asia-Pacific countries and territories in 2020. This is almost double the rate in upper-middle-income countries and territories in the region (57) and more than ten times that of high-income countries and territories (12) (Figure 3.22, left panel). Estimates for 2020 show a small group of countries – Korea, Singapore, Australia, Japan and New Zealand – with very low ratios (less than 10 per 100 000 live births). In contrast, the MMR was over 200 deaths per 100 000 live births in Cambodia, and over 150 in Papua New Guinea, Myanmar, Nepal, Indonesia and Pakistan. This is substantially above the target set by the Sustainable Development Goals of reducing the maternal mortality ratio to less than 70 deaths per 100 000 live births by 2030.
Despite high rates in certain countries, substantial progress in reducing maternal mortality has been achieved in the Asia-Pacific over the last 20 years (Figure 3.22, right panel). The MMR declined by over 50% between 2000 and 2020 across lower-middle- and low-income Asia-Pacific countries and territories. In particular, Lao PDR, Mongolia, India and Bangladesh achieved reductions in the maternal mortality rate of over 70%. In Lao PDR, the significant improvement in maternal health is the result of decades of investment in a national maternal health action plan. Key actions included strengthening antenatal care, leading to a 40% increase in the number of women giving birth in health facilities with skilled birth attendants. The plan also included increased routine monitoring and early detection, reducing the number of women needing referral to higher-level care.
Care by skilled health professionals during childbirth can save the lives of women and newborns (Figure 3.23). Nepal and Bangladesh report that less than 60% of live births are attended by skilled health professionals (see indicator “Pregnancy and birth” in Chapter 5) and present relatively high MMRs – above 120 deaths per 100 000 live births. While Cambodia has successfully expanded maternal care such that nearly all births are attended by a skilled health professional, the MMR rate remains highest in the region.
Antenatal care coverage is an indicator of access of healthcare during pregnancy. Evidence suggests that receiving antenatal care at least four times increases the likelihood of receiving effective maternal health interventions during the antenatal period. Coverage was nearly 100% in Brunei Darussalam, Korea, Malaysia and Singapore (Figure 3.23). Meanwhile, in Bangladesh – which has an MMR well above the regional average – only 40% of women received antenatal care four or more times. Evidence from Bangladesh suggests women from the poorest group, those in rural areas, with no education, a high birth order and no media exposure were less likely to receive high-quality antenatal care (Akter et al., 2023[3]).
