Addressing Gaps in Maternal Care across Pregnancy, Delivery, and Postpartum

20 Jan, 2026

Maternal care rarely collapses in a single moment. More often, it weakens quietly—between visits, between facilities, or after a woman has already returned home. On paper, most health systems provide services across pregnancy, childbirth, and postpartum recovery. In reality, these stages are frequently disconnected, allowing risk to accumulate unnoticed.

The persistence of maternal deaths makes this disconnect difficult to ignore. In 2020 alone, an estimated 287,000 women died from causes related to pregnancy, delivery, and the postpartum period. Most of these deaths were preventable. Their continued occurrence points less to clinical unknowns and more to gaps in how care is sustained across time.

Progress that has slowed, and in some places reversed

Globally, maternal mortality has declined compared to earlier decades, but progress has lost momentum. The global maternal mortality ratio stood at 223 deaths per 100,000 live births in 2020, far above the widely cited benchmark of 70. While this represents improvement from the year 2000, reductions have not been consistent in recent years.

Since 2016, meaningful declines have been observed in only a few regions. In others—including parts of Europe, North America, Latin America, and the Caribbean—maternal mortality has stagnated or increased. These trends suggest that improvements in infrastructure and access alone are no longer enough.

For maternal health systems, slowing progress is often a signal that fragmentation—not availability—is the limiting factor.

Pregnancy: early detection, limited follow-through

Most women engage with the health system during pregnancy. Screening for anemia, hypertension, diabetes, and obstetric history is widely practiced and generally effective at identifying risk.

What weakens outcomes is inconsistency over time. Pregnancy is not static, yet monitoring often is. Missed appointments, long travel distances, workforce constraints, or socioeconomic pressures disrupt continuity. Risk factors identified early are not always tracked with the same intensity later.

When follow-up weakens, manageable conditions quietly worsen. By the time delivery approaches, the clinical picture may be very different from what early records suggest.

Delivery: where system gaps become visible

Childbirth concentrates risk into a short, intense window. Outcomes here depend not only on skilled attendance but also on how well information from pregnancy travels forward.

Referral pathways are a frequent source of stress. Women may move between facilities with different capabilities and documentation practices. When prior risk factors are poorly communicated or arrive late, response time suffers.

Delivery itself may be handled competently, yet unresolved risks from pregnancy increase the likelihood of complications. This is why safe delivery alone does not guarantee maternal safety.

Postpartum care: the most fragile link

A large share of maternal deaths occur after childbirth, often days or weeks following discharge. Yet postpartum care remains the least structured phase of maternal services.

Conditions such as hemorrhage, infection, hypertensive disorders, and mental health complications frequently emerge during this period. Without a planned follow-up, symptoms may be overlooked or normalized until they escalate.

In many settings, postnatal care is limited to a single visit or inconsistently accessed. As a result, women often re-enter the system through emergency routes rather than routine care, by which point outcomes are harder to influence.

Postpartum care is not an extension of maternal services. It is a continuation that has been under-prioritized for too long.

Inequality beneath the averages

Between 2010 and 2020, nearly 3 million women died from pregnancy-related causes worldwide. These deaths were not evenly distributed. They were concentrated among women facing socioeconomic disadvantage, limited access to care, and fragile health systems.

Public health emergencies, conflicts, and disease outbreaks worsen these disparities. Services are disrupted, transport becomes unreliable, and routine care is delayed. In such contexts, fragmented maternal care pathways fail first, and women already at risk are affected most.

Why continuity matters more than expansion

Many maternal deaths do not result from rare clinical events. They arise from delayed recognition, weak escalation, and loss of responsibility between stages of care. Fragmented systems create predictable blind spots:

• Risks identified during pregnancy are not monitored consistently

• Delivery teams lack a complete clinical context

• Postpartum symptoms go unnoticed

• Accountability fades once discharge occurs

Strengthening the maternal care continuum

Improving outcomes depends less on adding services and more on connecting them. Effective maternal care treats pregnancy, delivery, and postpartum recovery as a single pathway.

Common elements of stronger systems include:

• Continuous monitoring of identified risks

• Clear referral and feedback mechanisms

• Structured postpartum follow-up

• Reliable information flow across care settings

In this model, clinical judgment remains central. Tools and systems support coordination rather than replace responsibility. For any healthcare service provider, continuity becomes the core safeguard against avoidable maternal complications.

What improves when gaps are addressed

When maternal care pathways are better connected, changes are often gradual but meaningful. Complications are detected earlier. Emergency readmissions decline. Women experience care as consistent rather than episodic.

When gaps persist, deterioration is slower but more costly. By the time intervention occurs, options are limited, and outcomes are harder to improve.

Moving forward

Maternal health outcomes depend not only on access to care, but on how reliably care follows women across pregnancy, delivery, and postpartum recovery. Fragmentation undermines even well-established systems.

Closing gaps across the maternal continuum remains one of the most practical ways to reduce preventable harm. Maternal care works best when responsibility does not end at delivery, and risk is not treated as episodic.

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