A new international commission will pave the way for a global boost in maternal and newborn health. The project is led by a researcher at Lund University in Sweden, whose motivation stems from a formative experience witnessing a woman bleed to death unnecessarily during childbirth. "The time has come to put maternal and newborn health back at the heart of the global health agenda," says Mehreen Zaigham.
"Our goal is for no mother or child to die during pregnancy or childbirth. That may sound unachievable, but it's only when we aim high that real change becomes possible," says Mehreen Zaigham, Associate Professor at Lund University and specialist in Obstetrics and Gynaecology, Skåne University Hospital who is chairing the upcoming Lancet Commission.
The Commission brings together researchers, lived-in experts, policymakers, and individuals with first-hand experience of healthcare. Together, they will develop concrete recommendations and a shared vision for strengthening maternal and newborn health worldwide. The goal is not only to save lives, but also to foster resilient, sustainable communities.
"Women's lives are precious. They are the bedrock of society, yet too often remain its most undervalued members. Investing in maternal health is an investment in the future, in our children, our families, and the very fabric of society," says Mehreen Zaigham.
An oft-quoted statement by a former president of the International Federation of Gynaecology and Obstetrics, Professor Mahmoud Fathalla, sums up the problem: " Women are not dying because of untreatable diseases. They are dying because societies have yet to make the decision that their lives are worth saving."
Unfortunately, the figures are bleak. Every two minutes, a woman dies as a result of complications related to pregnancy or childbirth, even though most of these deaths could be prevented. The most common causes - bleeding, infection and unsafe abortions - are well known and often treatable.
"As the world grapples with numerous other pressing challenges, maternal and newborn health has been pushed to the sidelines."
Ambitions have long existed. A goal of reducing the number of maternal deaths to 70 per 100,000 births by 2030 was set; today the figure is 193 maternal deaths per 100,000 births. A contributing factor to deaths being at this level is the increased medicalisation of maternity care. As an example, Mehreen Zaigham points to the number of caesarean sections having increased dramatically, with one in three babies worldwide being delivered by caesarean section.
"In Egypt, the rate has reached 70 per cent. This is a crisis because it means that as doctors and midwives, we are starting to lose important clinical skills in supporting women through natural births. With caesarean sections being the more common mode of birth in many countries around the world, we are seeing increasing complications as a result of these procedures, endangering the life of both the mother and baby."
There are many reasons behind the rapid increase in caesarean sections around the world, explains Mehreen Zaigham. It is partly due to women increasingly wanting to give birth by caesarean section, and partly because healthcare providers can more easily schedule births at times that suit them, along with financial incentives.
"Unfortunately, the way caesareans are sometimes portrayed in social media does not reflect the full picture of the procedure and its potential risks for mother and baby. Some cultures favour births on certain 'lucky' dates and consequently schedule caesarean sections on these dates. There are also financial incentives at work: in many countries, doctors earn more money from a caesarean section than from a natural birth."
Mehreen Zaigham notes that social media can influence women's attitudes towards caesarean sections, in addition to the medical information provided by healthcare professionals. Not everyone is aware that vaginal birth offers important protective benefits for both mother and baby - physically and hormonally.
Research shows that babies born by caesarean section are exposed to different hormonal, physical, bacterial and medical factors than babies born vaginally, which in turn affects their immunological development.
"For us to have any influence on rising caesarean section rates, we as medical professionals, need to educate our societies and provide evidence-based information to patients so they can make an informed choice."
There are of course situations where a caesarean section is medically indicated. But all health stakeholders agree that current levels are both unacceptable and harmful to both mothers and children.
The Lancet Commission will explore pressing needs within the field of maternal and newborn health. It will also explore the role that new technologies - such as digital health platforms, telemedicine and AI tools - can play in improving access to maternal and newborn care.
"Having worked in Pakistan, a country with limited resources, I know first-hand the desperation of losing a mother's life that could have been saved. Leading this work from Sweden, a country with some of the best maternal and newborn health outcomes in the world, offers a vital perspective to the Commission. It highlights the power of bridging global gaps in health outcomes, learning from one another's experiences, and driving meaningful change. Above all, it brings hope."
Two pivotal events defined Mehreen's trajectory.
"The first was when I was a student in Pakistan and witnessed a mother bleed to death during what should have been a routine caesarean section. I saw the helplessness of the surgeon, unable to do more because our facility had run out of blood and blood products. The second was a newborn girl with anaemia who needed an urgent transfusion. Her family refused, they already had three daughters, we were told. Fortunately, one of our colleagues shared the same blood type and donated his blood, saving her life. But the experience forced me to confront how undervalued female lives can be, a realisation that deeply pained me. After that, the decision to become an obstetrician and gynaecologist came easily."
It is hoped that the Commission will form one of the largest global collaborations for maternal and newborn health. The results will be presented in 2028.
Lancet commission
The Commission will pursue fundamental change for improving maternal and newborn health through a three-pronged strategy:
1. Critical assessments of past achievements and future challenges: reviewing best practices, and making evidence-based recommendations for the highest possible quality of maternal and newborn healthcare.
2. New ground-breaking research:
Multinational data collection investigating the reasons why mothers and newborns are still dying and looking into caesarean section access, indications, safety, and outcomes.
3. A roadmap for the future:
The Commission will produce a manifesto with powerful and concrete proposals that can make a real difference - and set the agenda for global maternal and newborn health for the next decade.
