Some 350,000 women die each year during pregnancy or soon after giving birth, with women in sub-Saharan Africa, Pakistan and Afghanistan facing the highest risks. Although global rates of maternal death have been dropping by about 1.5 percent each year since 1980, there is still a long way to go if countries hope to meet United Nations Millennium Development Goal (MDG) 5 by 2015—a 75 percent reduction in the number of maternal deaths per 100,000 live births from 1990 levels. Today, an average of 251 women die per 100,000 births, and only 23 countries are on track to reach the MDG, with some countries even moving in the wrong direction.

Approximately 15 percent of women everywhere develop pregnancy complications. These include infections (such as HIV), pregnancy-induced hypertension, obstructed labor and hemorrhage. Most can be managed with proper care, but many women simply do not receive it. “It’s not that you require a scientific breakthrough to solve these situations—in developed countries the knowledge and technical tools have been available to women for many, many years,” says Ana Langer, coordinator of the Dean’s Special Initiative on Women and Health at the Harvard School of Public Health. In many places, however, “women do not have access to them.”

In Africa, for instance, women often have to rely on the willingness of others to get obstetric care because of their low social status. “For women to have timely access to services that can help to save her life she still needs the community, husband and family to be able to provide access and transportation,” explains Grace Kodindo, an assistant clinical professor of population and family health at Columbia University’s Mailman School of Public Health.

Possibly as a result of these societal barriers, since 1980 the Ivory Coast and Zimbabwe have both experienced increases in maternal mortality rates—in Zimbabwe deaths have jumped by 5.5 percent each year in the past two decades, in part because of low female social status and ongoing political conflict. But even the wealthiest countries face problems in maternal health, including the U.S., where 17 women die per 100,000 live births. Inequalities, however, still leave the poorest and least educated women at the greatest risk. “The context may be different, but the bottom line is the same—they don’t have timely access to care,” Langer says.