The causes of maternal mortality and morbidity are no mystery. Women die and suffer debilitating disease and injury during pregnancy and childbirth because they bleed to death, acquire infections, have underlying but treatable health conditions, or obtain unsafe abortions.

The keys to improving maternal health are equally clear. Family planning information and services must be available and affordable to girls, adolescents, and women without discrimination or stigma. Pregnant women must have timely access to quality, respectful care before, during, and after childbirth. Abortions must be made safe and legal, and post-abortion care must be fully integrated into health systems. When women’s roles and contributions are valued, and their rights are recognized, maternal health programming and services will receive significant and enduring benefits.

Although valuable data about maternal health is being produced, and increasingly is being used to drive policy decisions, there has been a tendency to focus attention too narrowly on the perinatal period and the obstetric causes of death rather than on the social, political, and legal environments that endanger women’s health. This report examines the upstream threats to women and girls: the obstacles to accessing proper care and the structures that keep women from exercising their rights.

While the international community has prioritized maternal health through its Call to Action for ending preventable child, maternal, and newborn deaths, and the United States Agency for International Development (USAID) has issued a Vision for Action that recognizes many of the key barriers to progress, there has been little consideration of the donor systems and policies that undermine and contradict program goals. We hope this report will open a conversation about how those systems and policies can be strengthened.

This report is based on a review of published literature, accompanied by candid, not-for-attribution interviews with policymakers and practitioners from the U.S. government, non-profit partners, and advocacy organizations. Based on these interviews and studies, CHANGE identifies six policy challenges requiring attention from Congress and the Administration.

Improvements in U.S. policy and programming will not solve all the problems that make pregnancy and childbirth so dangerous for women around the world. However, they will ensure that U.S. resources are targeted effectively and used efficiently to empower women to seek and receive the care they need.