In early June, Melinda French Gates pledged US$215 million to improve women's health globally, with a focus on underfunded areas such as maternal care in Africa. The announcement comes at a critical moment. Every day, more than 700 women die during and following pregnancy and childbirth, though many of the leading causes of maternal mortality are preventable with affordable, evidence-based interventions.
These maternal deaths are not evenly distributed. Roughly 87% of them occur in Southern Asia and sub-Saharan Africa, with the latter alone making up nearly 70%. By contrast, high-income countries experience far lower rates, although stark inequities remain.
As calls for local resource mobilisation grow louder, the focus should shift to cost-effectiveness. Instead of investing in expensive hospital-centred models, policymakers should scale up funding for affordable interventions that address the leading causes of maternal mortality, which include postpartum haemorrhage, hypertensive disorders such as pre-eclampsia, unsafe abortion complications, obstructed labour and sepsis.
While working in Nigeria on a project aimed at preventing postpartum haemorrhage -- the leading killer of women during childbirth -- in communities and at health facilities, I saw firsthand how simple, affordable interventions saved lives.
For starters, active management of the third stage of labour can reduce severe postpartum haemorrhage by about 60-70%. This involves administering medicine that helps the womb contract after childbirth, at which point healthcare workers can actively control the delivery of the placenta and assess the mother's uterine tone. While oxytocin is the preferred drug, proper storage can be challenging in low-resource settings; misoprostol is an effective and affordable alternative that is heat-stable and can be given orally.
Accurately measuring blood loss is equally important. A simple plastic blood collection drape, placed under the woman immediately after delivery, makes this possible.
Pre-eclampsia, which affects 3-8% of women who give birth worldwide, also threatens the lives of mothers because, when left untreated, it can progress to deadly seizures. Fortunately, the best solution is one of the simplest: regular blood-pressure monitoring. Between 2014 and 2017, the Community-Level Interventions for Pre-eclampsia programme trained community health workers to visit pregnant women at home, monitor blood pressure and identify warning signs using mobile tools and pictorial guides. The trial improved early detection and management of pre-eclampsia in Mozambique, Pakistan and India, with workers treating low-risk cases with antihypertensives and magnesium sulphate, and urgently referring high-risk patients to health facilities.
Complications from unsafe abortions are another prominent cause of maternal deaths, accounting for roughly 8% globally.
The answer is straightforward: expand access to safe abortion services. Ethiopia liberalised its abortion law in 2005, making these services and crucial follow-up care available in public health facilities. Healthcare workers were trained to provide women with treatment for severe bleeding and infections, and to remove pregnancy tissue left behind after incomplete abortions, with more complicated cases referred to hospitals. Within a decade, the share of maternal deaths linked to unsafe abortion fell from 32% to less than 10%.
Finally, obstructed labour, which occurs when a baby cannot pass through the birth canal even with strong contractions, can lead to severe bleeding, infection, uterine rupture, stillbirth and death when not treated promptly. The solution to this problem, which accounts for about 2% of maternal deaths worldwide, is timely access to skilled birth attendants and emergency obstetric care, including caesarean sections when necessary.
Bangladesh achieved a rapid reduction in maternal mortality -- including deaths from obstructed labour -- through a multi-sectoral approach. It increased access to specialised emergency care for women with serious childbirth complications, allowed the growth of private medical facilities to meet demand for caesareans, and promoted early referral through community-based birth attendants.
While Ms French Gates' funding commitment is both timely and welcome, the future of maternal health, particularly in countries that have long depended on foreign aid, cannot rest on philanthropy alone. It must be built on sustained investments in simple, proven and scalable interventions that make better use of scarce resources to ensure that no woman dies while giving life. ©2026 Project Syndicate
Ifeanyi M Nsofor is a public-health physician and Co-Founder of the Africa Behavioral Science Network.
