Maternal Health Policy: Recommendations for Equitable Pregnancy Care

Pregnancy is a critical period that shapes the health and well-being of women, infants, families, and communities. It underpins optimal fetal growth and development. Despite a 40% reduction in the global maternal mortality ratio (the number of mothers dying from pregnancy or childbirth per 100,000 live births) between 2000 and 2023, progress has slowed over the last decade.

Achieving the Sustainable Development Goal (SDG) target of 70 maternal deaths per 100,000 live births by 2030 will require an annual reduction of nearly 15% over the next seven years, compared with the average annual reduction of 2.2% achieved over the past 15 years.

Progress is hampered by the complex biological, social, cultural, economic, and environmental determinants of maternal health. These exposures and risk factors directly influence fetal growth, placental function, and developmental trajectories.

Maternal Health Policy Context

Governments at all levels have a responsibility to protect women’s health, rights, and well-being during pregnancy. This includes ensuring comprehensive and equitable access to quality care that supports maternal health and optimal fetal growth and development.

Evidence-based antenatal, intrapartum (labor and delivery), and postnatal care improves maternal and newborn outcomes and forms the core of WHO recommendations. However, translating global guidance into practice remains challenging, particularly in countries bearing the greatest burden of maternal morbidity and mortality. A broader, multipronged approach is needed to address the determinants of maternal health beyond the healthcare system.

Preventable maternal mortality is not solely attributable to biological factors related to pregnancy, childbirth, and the postnatal period. It also reflects persistent inequities in global health and socioeconomic development. These inequities contribute to poor fetal growth, adverse birth outcomes, and compromised early development, perpetuating intergenerational cycles of disadvantage. In 2023, countries classified as being in conflict accounted for 61% of global maternal deaths despite representing only 25% of global live births. Emerging evidence also links climate change drivers with adverse maternal and neonatal health outcomes.

Indigenous women, women from refugee and migrant backgrounds, adolescents, women living in poverty or remote areas, and women with disabilities or complex social circumstances face disproportionately higher rates of stillbirth, obstetric complications, fetal growth restriction and adverse neonatal outcomes.

These disparities are rooted in structural discrimination, limited access to high-quality care, social exclusion and systemic barriers to support. Maternal and neonatal health must therefore be prioritized in the planning and monitoring of pregnancy-related programs.

International commitments and implementation

Progress requires investment and capacity building to achieve universal health coverage and strengthen prevention, early identification of complications, health literacy and continuity of care throughout pregnancy. Woman-centered care, grounded in autonomy, dignity, respect and cultural safety, is essential to building trust and achieving equitable health outcomes.

Pregnant people face heightened vulnerabilities during public health crises, including pandemics, climate-related disasters, forced displacement and humanitarian emergencies. Health systems must ensure continuity of pregnancy care, safeguard human rights and maintain access to essential services that support healthy fetal development. These measures are central to emergency preparedness and response. Promoting pregnancy health therefore requires a holistic approach that integrates clinical care, health promotion, social support and rights-based policy action.

Purpose and Scope of the Policy

This policy statement provides a framework to guide governments, health systems, civil society and global partners in promoting the health, rights and wellbeing of all pregnant people. It emphasizes a rights-based, equity-focused and woman- and person-centered approach that integrates health promotion, quality clinical care and social support throughout pregnancy and the postnatal period.

Recommendations for Equitable Pregnancy Care

The World Federation of Public Health Associations recommends that Public Health Associations and health professionals advocate for the following actions:

1. Promoting a Healthy Lifestyle During Pregnancy

Promoting healthy behaviors during pregnancy is central to preventing adverse maternal and neonatal outcomes. The WHO recommends education and counseling to support a healthy diet by increasing the diversity and amount of food consumed, promoting adequate but not excessive weight gain through sufficient, balanced protein and energy intake, and encouraging consistent use of micronutrient supplements, food supplements, or fortified foods. Nutrition guidance must be culturally appropriate and tailored to individual needs.

Safe, regular physical activity throughout pregnancy, aligned with guidelines, helps reduce complications such as gestational diabetes and hypertensive disorders. Women should receive clear guidance tailored to their health status and stage of pregnancy.

Preventing harmful exposures

WHO guidelines recommend routine screening for tobacco use, vaping, alcohol consumption, substance use, and prescription medications during pregnancy. Women should be offered stigma-free, supportive interventions, including motivational interviewing and referral to specialized harm-reduction or cessation services when needed. A zero-alcohol recommendation should be consistently communicated before and during pregnancy to prevent Fetal Alcohol Spectrum Disorder and other harms resulting from prenatal alcohol exposure.

Oral health is an essential component of antenatal care. Preventive dental care and timely treatment reduce the risk of periodontal disease, which is associated with adverse pregnancy outcomes. Guidance on safe sexual activity during pregnancy should address common myths and concerns.

2. Advancing Quality, Woman-Centred Pregnancy Care

Improving pregnancy outcomes requires high-quality, woman-centered maternity care that respects the rights, dignity and autonomy of all pregnant people. Health systems must provide respectful, culturally safe care grounded in shared decision-making, enabling women to make informed choices about pregnancy, birth and postnatal care.

Continuity-of-care models, particularly those led by midwives, can improve outcomes and strengthen trust, safety and satisfaction. Quality pregnancy care must also include diverse populations.

3. Providing Essential Antenatal, Birth and Postnatal Care

The most common direct causes of maternal injury and death include excessive blood loss, infection, high blood pressure, unsafe abortion and obstructed labor. Timely management can prevent many of these outcomes. Universal access to antenatal care is fundamental to maternal health, and antenatal visits must align with best-practice evidence in both content and frequency.

Early and continuous antenatal care

Early engagement, ideally within the first 10 weeks of pregnancy, supports accurate assessment, timely screening and early identification of potential complications. Integrated referral pathways connecting primary care, specialist providers and community services help ensure that women with emerging risk factors receive appropriate, coordinated support.

Antenatal care should also prepare women and their families for labor, birth, and early parenting. Education should cover consent, labor choices, pain management, postpartum expectations, contraception and pregnancy spacing, mental health, and blood pressure monitoring to prevent and manage maternal hypertensive disorders. It should also address follow-up screening, including oral glucose tolerance testing after gestational diabetes.

Preventing and managing postpartum hemorrhage

The WHO, the International Federation of Gynecology and Obstetrics (FIGO) and the International Confederation of Midwives launched consolidated guidelines for the prevention, detection and treatment of postpartum hemorrhage, the leading cause of maternal morbidity and mortality globally.

These guidelines highlight postpartum hemorrhage prevention and management as an equity intervention and identify quality antenatal and postnatal care as core components. They also provide an evidence-based rationale for revisiting clinical practice and policy definitions of postpartum hemorrhage. Adapt and implement the recommendations at scale to improve early diagnosis and timely intervention.

Supporting breastfeeding

Breastfeeding is a key determinant of infant and maternal health, yet less than 50% of children globally are breastfed as recommended in WHO guidelines.

Counseling on the benefits of breastfeeding, latch and positioning, and addressing early challenges should begin during pregnancy and continue throughout the postpartum period. Midwives, lactation consultants, peer supporters, and community health workers all play essential roles in supporting breastfeeding success.

4. Identifying and Managing High-Risk Pregnancies

Early identification and management of high-risk pregnancies are core functions of antenatal care. Screening should assess risks related to maternal weight, nutrition, smoking, alcohol and other drugs, social determinants, congenital infections, and sexual or mental health to enable timely intervention and referral.

Women with pre-existing chronic conditions, including diabetes, hypertension, cardiovascular disease, autoimmune conditions and cancer, or states of immunosuppression, including those related to medical treatment or HIV, require early risk stratification, multidisciplinary care and individualized management plans throughout pregnancy and the postpartum period.

Screening and managing pregnancy complications

Pregnancy complications must be managed through routine screening, evidence-based clinical pathways, and timely escalation of care. These include:

• Hypertensive disorders
• Gestational diabetes
• Intrauterine growth restriction and small-for-gestational-age infants
• Infection and sepsis
• Preterm birth

Women with a history of miscarriage, stillbirth, preterm birth or gestational diabetes, or a family history of diabetes, require enhanced screening, monitoring and tailored care plans. These should aim to minimize recurrence risks and support positive outcomes through postpartum risk counseling, dietary and lifestyle education, and preventive strategies to reduce progression to type 2 diabetes following gestational diabetes.

5. Supporting Perinatal Mental Health and Emotional Wellbeing

Pregnancy is a period of heightened vulnerability. Health systems must prioritize perinatal mental health, psychosocial wellbeing and safety.

Routine psychosocial screening helps identify depression, anxiety, trauma, stress, domestic or family violence, and reproductive coercion, including pressure to continue or terminate a pregnancy. Pregnant women must be offered confidential, respectful and stigma-free care that prioritizes safety, autonomy and empowerment.

Screening for postpartum depression should be integrated into postnatal care using validated tools and clear referral pathways for assessment and appropriate support. Early identification and management of maternal depression are essential to protect maternal wellbeing and infant care and development.

6. Preventing and Managing Communicable Diseases

Screening, prevention and management of communicable diseases are critical components of antenatal care. Universal testing for HIV, syphilis and other sexually transmitted infections supports early identification and treatment, reducing the risk of transmission to the fetus and adverse outcomes in offspring.

Hepatitis B and C screening and management, including vaccination, antiviral treatment where appropriate, and neonatal prophylaxis, are essential to protecting maternal and newborn health.
Assessment of vaccination status is an integral part of antenatal care. Maternal immunization provides direct protection during pregnancy and passive immunity to the newborn. Vaccines recommended during pregnancy include influenza and diphtheria–tetanus–pertussis (DTPa). HPV vaccination may also be relevant in pre-pregnancy care.

7. Strengthening Health Systems and Public Health

High-quality pregnancy care depends on strong, equitable and resilient health systems. Investment in workforce training, including cultural competence, cultural safety, trauma-informed care and woman-centered practice, is essential to improving care quality and reducing disparities.

The WHO recommends improving antenatal care by using women-held case notes, shifting tasks such as health promotion and malaria prevention to other health workers and, where needed, community health workers, and scheduling antenatal contacts to improve utilization and quality of care.

Improving access and continuity of care

Access to healthcare must be prioritized for rural and remote communities, women experiencing financial hardship, and groups facing systemic discrimination. The WHO provides criteria for training skilled birth attendants and guidance for countries with low coverage. It also supports task shifting among health professionals to improve maternal and newborn outcomes.

Effective collaboration and continuity of care between primary and tertiary services, including general practice, midwifery, obstetric and pediatric care, are essential for timely referral, coordinated management of complications, and seamless transitions across antenatal, intrapartum, and postnatal care. Strong data and surveillance systems are also needed to monitor outcomes, identify inequities, and continuously improve services.

Addressing social determinants and protecting pregnancy during crises

Cross-sector collaboration across health, social care, housing, child protection and community organizations is crucial to addressing the complex social determinants of maternal health.
Health systems must ensure safe, continuous and respectful maternity care in humanitarian and fragile settings, where conflict, displacement and resource constraints substantially increase maternal and neonatal risks.

Embedding the right to health in legislation, policy and implementation frameworks is fundamental to achieving equitable pregnancy outcomes. All pregnant people must be able to access the individualized care they need, regardless of background or circumstance.

Read the original Pregnancy Policy here, which includes all detailed references.

Editors’ note: This policy primarily uses the term “pregnant people” to reflect all individuals who may experience pregnancy. However, “pregnant women” is retained where it reflects the original language of cited policies, guidelines, or source documents. Both terms refer to pregnant individuals and are used interchangeably to stay consistent with source material and align with existing policy language.