Government Health Spending Cuts and EU Maternal Mortality

Author: Wiley
Published: 12 Dec 2014 - Updated: 12 Oct 2026
Publication Details: Peer-Reviewed | Research, Study, Analysis

Table of Contents:
Synopsis - Definition - Overview - FAQs - Insights, Updates - Related Content

Synopsis

This research, a peer-reviewed retrospective study published in BJOG: An International Journal of Obstetrics and Gynecology, examined 30 years of World Health Organization data to measure how changes in government healthcare spending affected maternal deaths across the European Union. The key finding is that each 1% drop in public health spending was tied to an average 10.6% yearly increase in maternal mortality, an effect that lasted for a year after the cut. The link faded once researchers accounted for the share of births attended by trained doctors, midwives and nurses, which points to skilled birth attendance as the likely factor that suffers when budgets shrink. The work matters to policymakers, health planners and expectant mothers, and especially to women with disabilities and older mothers who already face higher pregnancy risks and rely more heavily on publicly funded care, because it gives hard numbers to a question often argued in the abstract during periods of austerity.*

At a Glance

1 - Data covered 24 EU countries with a combined population of 419 million people in 2010.
2 - Maternal mortality figures for the analysis came from the World Health Organization database.
3 - The link held after controlling for economic, infrastructure, hospital resource and fertility rate factors.
4 - Co-author Professor Thomas Zeltner noted that quality of care may hold if budget cuts are matched by sufficient gains in efficiency.

Topic Definition

Maternal Mortality: Maternal mortality is the death of a woman while pregnant or within 42 days of the end of a pregnancy, from any cause related to or made worse by the pregnancy or its management, but not from accidental or incidental causes. It is usually reported as the maternal mortality ratio, which counts the number of maternal deaths per 100,000 live births in a given period, and it is one of the most widely used indicators of a health system's overall quality and of women's access to skilled care before, during and after childbirth.

Overview

Reductions in government healthcare spending in the European Union (EU) are associated with increased maternal mortality rates, suggests a new paper published on December 10, 2014, in BJOG: An International Journal of Obstetrics and Gynecology (BJOG). However, after accounting for the percentage of births attended by skilled health professionals, the association was no longer statistically significant, highlighting the potential importance of maternal care, finds the research.

The study looks at the association between reductions in government healthcare spending (GHS) and maternal mortality across the European Union (EU) over a 30 year period from 1981 to 2010.

Maternal mortality is defined as the death of a woman while pregnant or within 42 days of the end of pregnancy, from any cause related to or aggravated by the pregnancy or its management. GHS is the total expenditure on health care by a government measured as a percentage of gross domestic product (GDP).

This study used data on maternal mortality from the World Health Organization (WHO) database. Data were available for 24 EU countries, a population of 419 million people (2010).

The study found that for every 1% decrease in government healthcare spending, EU countries experienced an average 10.6% annual increase in maternal mortality. This association also remained significant for 1 year after the spending cut.

Moreover, the study found that the association remained significant after accounting for economic, infrastructure and hospital resource controls, in addition to out-of-pocket expenditure, private health spending and the total fertility rate. However, when accounting for the percentage of births attended by skilled health professionals, defined as people trained to give the necessary supervision, care and advice to women during pregnancy, labor and the postpartum period, the effect is no longer significant.

Professor Thomas Zeltner, University of Bern, Switzerland, Special Envoy for Financing to the Director General of the World Health Organization and co-author of the paper said:

"With reduced government spending in this area in times of austerity, policy makers need to be aware of the consequences of the budget cuts. If cost-reductions are matched by sufficient increases in efficiency, quality of care may remain."

"Our results suggest that reductions in government healthcare spending are associated with increased maternal mortality rates in the EU. This may occur due to a variety of reasons such as reductions in the number of births attended by skilled health professionals."

John Thorp, BJOG Deputy-Editor-in-Chief, said:

"This paper covers a large amount of time and is one of the only studies to look at this."

"It is clear that skilled attendants such as doctors, midwives and nurses who have been adequately trained to manage uncomplicated as well as complicated pregnancies, childbirth and the postnatal period are crucial to maximizing safety and survival of women and their infants."

BJOG

An International Journal of Obstetrics and Gynecology is owned by the Royal College of Obstetricians and Gynecologists (RCOG) but is editorially independent and published monthly by Wiley. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynecology worldwide.

Reference:

Maruthappu M, Ng KYB, Williams C, Atun R, Agrawal P, Zeltner T. The association between government healthcare spending and maternal mortality in the European Union, 1981-2010: a retrospective study. BJOG 2014.

Frequently Asked Questions

NOTE: Researched FAQs by Disabled World (DW)

How is the maternal mortality ratio calculated?

The maternal mortality ratio is calculated by dividing the number of maternal deaths in a period by the number of live births in the same period and multiplying the result by 100,000. This allows countries of very different sizes to be compared fairly.

What is a late maternal death?

A late maternal death is a death from direct or indirect obstetric causes that occurs more than 42 days but less than one year after the end of a pregnancy. Many health agencies now track these deaths because conditions such as heart disease and postpartum complications can be fatal months after delivery.

What are the leading causes of maternal death worldwide?

The leading causes include severe bleeding, high blood pressure disorders such as preeclampsia, infections, complications from unsafe abortion and blood clots. In high-income countries, pre-existing conditions such as cardiovascular disease make up a growing share of maternal deaths.

How many women die from pregnancy-related causes each year?

The World Health Organization estimates that about 260,000 women died from pregnancy and childbirth-related causes in 2023. Most of these deaths occurred in low and lower-middle income countries, and most were preventable.

Do women with disabilities face higher risks during pregnancy?

Research shows that women with physical, sensory, intellectual and developmental disabilities have higher rates of serious pregnancy complications and maternal death than women without disabilities. Barriers to accessible prenatal care, inaccessible equipment and gaps in provider training all contribute to these risks.

How does maternal mortality in the United States compare with Europe?

The United States has the highest maternal mortality ratio among high-income nations and a rate several times higher than many European countries. Experts point to gaps in insurance coverage, limited access to midwifery care and higher rates of chronic illness as contributing factors.

Who is responsible for health care funding in the European Union?

Health care funding and delivery are mainly the responsibility of each EU member state rather than the EU itself. The EU supports national systems through public health programs, research funding and coordination, but national governments set their own health budgets.

What can expectant mothers do to lower their risk of complications?

Expectant mothers can lower their risk by starting prenatal care early, managing existing conditions such as diabetes or high blood pressure, and planning to give birth with a skilled attendant present. Knowing the warning signs of postpartum complications and attending follow-up visits after delivery is also important.

Insights, Analysis, and Developments

Editorial Note: Few public health studies follow a single question across three decades and two dozen countries, which is what gives this analysis its weight. The pattern it describes is simple: when governments cut health budgets, maternal deaths tend to rise, and the protection appears to come from having trained professionals at the bedside during labor and delivery. That finding offers budget planners a practical takeaway - protect midwifery and obstetric staffing first - and it carries particular meaning for women with disabilities, those with chronic conditions and women having children later in life, all groups for whom gaps in skilled care can turn a manageable complication into a fatal one. More than a decade after publication, as health systems across Europe and beyond continue to face financial pressure, the study remains a clear reminder that spending decisions on maternity services are measured in lives.*

Attribution/Source(s): This peer reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by Wiley and published on 12 Dec 2014, this content may have been edited for style, clarity, or brevity.

* Editorial additions by Ian C. Langtree.