The maternal mortality ratio (MMR) is the most widely used measure of maternal deaths and a measure of obstetric risk. It is widely acknowledged as a broader indicator of population health, the status of women in society, and the functioning of health systems, and remains a central focus of the regional Zero Preventable Maternal Deaths initiative. 

The MMR in the Region increased from 56.9 maternal deaths per 100 000 live births in 2015 to 58.5 in 2023, representing a 2.8% increase over the period. The rate is projected to reach 56.8 deaths per 100 000 live births by 2025. Although the trend has begun to return to its pre-pandemic trajectory, there was a marked deterioration during the COVID-19 period, with a peak of 106.8 deaths per 100 000 live births in 2021. Despite the subsequent recovery, the regional target was not achieved and progress is stagnating. 

The trend reflects the combined effects of pandemic-related disruptions to essential health services, delayed access to antenatal and intrapartum care, and longstanding structural weaknesses in the organization, quality, and coverage of maternal health services, including access to modern contraception. Persistent bottlenecks include insufficient prioritization of maternal health within health systems, uneven availability of skilled care and emergency obstetric services, stock-outs of essential supplies, and inadequate targeting of populations and territories in situations of greater vulnerability. Significant data gaps remain, particularly in the timeliness, completeness, and subnational disaggregation of data needed to guide urgent corrective action. 

Despite the adverse trend in the Region, since 2022 the MMR has declined in 10 of the 12 countries prioritized by PAHO for action through institutional coordination and accelerated technical cooperation. Across the Region, countries, together with the Bureau and partners, have continued efforts to reduce maternal mortality by strengthening maternal health policies, improving the use of national and subnational data to target interventions, promoting integrated territorial responses informed by georeferencing analysis, and supporting the implementation of evidence-informed approaches to prevent avoidable maternal deaths. Although these efforts have helped sustain momentum around the maternal health agenda, progress has remained insufficient to offset pandemic-related setbacks and accelerate the decline required to meet the regional targets for 2025 and 2030. As this indicator will continue to be monitored under the PAHO Strategic Plan 2026–2031, addressing longstanding challenges and accelerating efforts will remain crucial.