The world loses a mother every two minutes to pregnancy complications. Women in low-income countries face most of that risk, with their odds of survival 36 times lower than in a wealthier nation. But within a country, risks for mother and baby vary dramatically as well. An infant is more likely to survive its first year if it lives in an urban area rather than a rural one. What causes this disparity – and how can we help?

Highlighted figures are from the World Health Organization.

Every two minutes there's 1 maternal death, 8 stillbirths and 9 newborn deaths.

Many women in rural areas never see a doctor during pregnancy and give birth at home. If something goes wrong during labour, the time it takes to reach the nearest facility can mean the difference between life and death.

A community midwife will be familiar with the family and aware of any health problems that could complicate labour. She can offer advice during pregnancy, provide rapid assistance, birth support and emergency care within the home, and support the new mother and baby.

83% of all maternal deaths, stillbirths and newborn deaths can be averted if quality midwifery care is available.

We’ve taught 7,000 nurses and midwives to degree standard in East Africa and Pakistan. We’ve also trained thousands of community nurses and midwives to provide primary health care where little to none exists. These include women in Afghanistan, deployed to rural areas and greatly increasing the number of deliveries attended by skilled birth attendants.

A baby who gets the right nutrients during her first 1,000 days of life – from conception to age two – stands a better chance to grow well, succeed in school, stay healthy during her life – and deliver a healthy baby one day.

Without the right nutrients a baby risks low birthweight, a problem that is more prevalent in rural areas and makes infant death 20 times more likely. In 10 countries across Africa and Asia, we're providing vitamin and mineral supplements to expectant and new mothers, training healthcare workers to spot and treat malnutrition, and educating them to support good nutrition and breastfeeding. Read more

Low birthweight makes infant death 20 times more likely.

“The idea is to prevent low birthweight in the first place," explains Dr Claudia Hudspeth, Global Health and Nutrition Lead for the Aga Khan Foundation. “In addition to working with children and pregnant women we are also focusing on nutrition in adolescent girls. We work across generations to ensure that when a mum gets pregnant, she is well-nourished to prevent the baby from being undernourished, and if the baby is undernourished, to tackle it quickly so that they get back on track.”

A pregnant woman drinking saline water risks complications during and after labour. Without access to toilets, she might drink less and become dehydrated. Her birthing assistant may have unwashed hands. If the drinking water is contaminated with sewage, she could get potentially dangerous diarrhoea. This is also a leading cause of death among children under two.

Rural areas face higher risks due to poor water infrastructure. Clean water, toilets and good hygiene are all part of the solution. We provide safe drinking water and sanitation to over 1.7 million people. Our agencies help communities identify water sources, improve infrastructure, and raise health and hygiene awareness.

In remote areas, getting medical care can be difficult and expensive for pregnant women, often requiring days of travel and a week's wages.

AKDN agencies work to reduce these barriers: from clearing roads after avalanches and rebuilding flood-damaged bridges, to deploying teleconsultations and digital health apps in over 100 health facilities. We have provided over 80,000 teleconsultations.

Additionally, community savings groups offer emergency health funds to alleviate unexpected costs. Gul Mahoor, who manages one in Nasirabad, Pakistan, recalls: “In her last few days of pregnancy, a woman was referred to Gilgit, 80 kilometres away, for an operation. Her husband came in at midnight and asked for money for transport. The operation was successful and she now has a healthy daughter.”

“The large inequities in maternal and infant care underline the need for effective and user-friendly provision of affordable services, which is mainly about overcoming health system constraints,” says Dr Gijs Walraven, AKDN Director for Health. “Private, not-for-profit providers like AKHS [Aga Khan Health Services] can support struggling health systems through public-private partnerships, scaling up the benefits for larger populations.”

In Pakistan, the government works with NGOs like AKHS to manage 2,000 basic health facilities, many in rural areas. Expectant mothers in some of the hardest to reach places can now access nearby facilities.

NGOs are also leveraging existing infrastructure to make improvements. In mountainous Gilgit-Baltistan, AKDN and partners are trialling clean birth kits distributed by Pakistan’s Lady Health Workers.

In Tanzania, upgrades to Nansio Hospital on remote Ukerewe Island, with new equipment, an operating theatre and trained staff, mean that pregnant women do not have to take a ferry to the mainland for specialised care. A partnership between Canada, Tanzania and AKDN, the upgrades for Nansio and 79 other health facilities in the region are part of a programme that is improving health care for 700,000 women and infants.

Find out more about AKDN’s approach to improving health care in lower-income countries.