A girl born currently in a peaceful country faces a lifetime risk of 1 in 593 of dying from pregnancy-related causes. If she is born in a conflict zone, that risk rises sharply to 1 in 51. For millions of adolescent girls, survival depends not only on medicine but also on geography.

A new technical brief released by the World Health Organization (WHO) shows that nearly two-thirds of maternal deaths occur in countries affected by conflict or institutional fragility.

The report adds that 160,000 women likely died from preventable maternal causes in fragile and conflict-affected settings in 2023. That represents 6 in 10 maternal deaths worldwide. Yet these countries account for only about one in ten global live births.

The disparities are stark. Conflict-affected countries recorded a maternal mortality ratio (MMR) of 504 deaths per 100,000 live births. Institutionally and socially fragile countries had an MMR of 368. Stable countries reported a far lower figure of 99.

The Maternal Mortality Ratio simply counts how many women die from pregnancy or childbirth complications for every 100,000 babies born alive. It shows how safe pregnancy is in a given country. A higher number means weaker access to timely care.

The “lifetime risk” figure makes the crisis personal. It estimates the chance that a 15-year-old girl will eventually die from a maternal cause during her reproductive years. In 2023, a 15-year-old living in a conflict-affected country faced a 1 in 51 lifetime risk. In institutionally fragile settings, the risk was 1 in 79. It dropped to 1 in 593 in comparatively stable nations.

The report confirms what doctors and nurses have long known. Crises break health systems. Armed conflict damages hospitals and forces families to flee. Supply chains collapse. Skilled staff leave. Emergency services such as caesarean sections and blood transfusions become harder to access. As a result, the risk of dying in each pregnancy can be nearly five times higher than in stable nations.

Risk also rises when conflict overlaps with gender discrimination, ethnicity, young age or migration status. Pregnant adolescents and displaced women often struggle to reach skilled birth attendants. Many arrive too late for lifesaving care.

The brief also highlights what works. In Colombia, health authorities trained traditional birth attendants. This strengthened trusted local networks and improved referrals in remote or insecure areas. Ethiopia restored services using mobile health teams, renovated facilities with additional midwives. These steps helped rebuild continuity of care.

Haiti removed cost barriers by offering free or low-cost caesarean sections. Reliable electricity in maternity wards ensured safe surgery for displaced women. In Myanmar, Papua New Guinea, and Ukraine, health officials reorganised patient pathways and protected essential maternity services, despite instability.

By linking maternal mortality data to fragility levels, WHO and partners now offer a clearer tool for action. The report stresses investment in primary healthcare. It calls for stronger data systems so no death goes uncounted. It also urges countries to design resilient services that can adapt during shocks.

For a 15-year-old girl today, the odds should not depend on whether her country is at war. The figures expose a deep global inequality. They also show that practical solutions can save lives. With focused investment and political will, preventable maternal deaths do not have to remain a generational gamble.