Global progress in reducing deaths of pregnant women, mothers and babies has flatlined for eight years due to decreasing investments in maternal and newborn health, according to a new report from the United Nations (UN).

The report shows that over 4.5 million women and babies die every year during pregnancy, childbirth or the first weeks after birth – equivalent to 1 death happening every 7 seconds – mostly from preventable or treatable causes if proper care was available.

“Pregnant women and newborns continue to die at unacceptably high rates worldwide, and the COVID-19 pandemic has created further setbacks to providing them with the healthcare they need,” said Dr Anshu Banerjee, Director of Maternal, Newborn, Child and Adolescent Health and Ageing at the World Health Organization (WHO).

“If we wish to see different results, we must do things differently. More and smarter investments in primary healthcare are needed now so that every woman and baby – no matter where they live – has the best chance of health and survival.”

The report meanwhile ranked Afghanistan among the 10 countries with the highest number of deaths in 2020.

India had the most maternal deaths, stillbirths and newborn deaths globally, with 788,000. Afghanistan was ranked number nine, with 95,000 deaths.

Overall, the report shows that progress in improving survival has stagnated since 2015, with around 290,000 maternal deaths each year, 1.9 million stillbirths – babies who die after 28 weeks of pregnancy – and a staggering 2.3 million newborn deaths, which are deaths in the first month of life.

The report states that funding shortfalls and underinvestment in primary healthcare can devastate survival prospects. For instance, while prematurity is now the leading cause of all under-five deaths globally, less than a third of countries report having sufficient newborn care units to treat small and sick babies. Meanwhile, around two thirds of emergency childbirth facilities in sub-Saharan Africa are not considered fully functional – meaning they lack essential resources like medicines and supplies, water, electricity or staffing for 24-hour care.

In the worst-affected countries in Sub-Saharan Africa and Central and Southern Asia – the regions with the greatest burden of newborn and maternal deaths – fewer than 60% of women receive even four, of WHO’s recommended eight, antenatal checks.

“The death of any woman or young girl during pregnancy or childbirth is a serious violation of their human rights,” said Dr Julitta Onabanjo, Director of the Technical Division at the United Nations Population Fund (UNFPA).

To increase survival rates, women and babies must have quality, affordable healthcare before, during and after childbirth, the agencies say, as well as access to family planning services, the UN stated.

More skilled and motivated health workers, especially midwives, are needed, alongside essential medicines and supplies, safe water, and reliable electricity. The report stresses that interventions should especially target the poorest women and those in vulnerable situations who are most likely to miss out on lifesaving care – including through critical subnational planning and investments.