Public Release: 

A matter of birth and death: Unsafe conditions still killing new mothers and newborns

New publication reports that a lack of safe water, sanitation and hygiene in birth settings is killing mothers and newborns in the developing world

London School of Hygiene & Tropical Medicine

A matter of birth and death: Unsafe conditions still killing new mothers and newborns

  • New publication reports that a lack of safe water, sanitation and hygiene in birth settings is killing mothers and newborns in the developing world

  • Call by nine leading health organisations for governments to act to save lives and enable skilled health workers to do their jobs

WaterAid and the London School of Hygiene &Tropical Medicine today join the World Health Organization, UNICEF, UNFPA, SHARE Research Consortium and other organisations in a call to protect the lives of new mothers and their babies, by improving access to safe water, basic sanitation and hygiene in healthcare facilities and homes.

A paper published in PLOS Medicine argues that despite improvements in health care, new mothers and newborns are still dying because a reliable supply of safe water, good hygiene practice and adequate toilets are often not present.

A companion paper in PLOS ONE illustrates the situation in Tanzania, where less than a third (30.5%) of births occur in places with safe water and basic sanitation. In 2013, one in 44 women in the country faced dying in childbirth in their lifetime.

Women face a similar level of risk in many developing countries. Globally, an estimated 289,000 women died from complications related to pregnancy or childbirth in 2013 [1], a number which researchers say can be more rapidly reduced through better provision and monitoring of safe water, basic sanitation and hygiene to prevent infection and improve care.

Some 38% of healthcare facilities in 54 low-income countries are without an improved water source, according to a forthcoming survey [2], leaving doctors, nurses and midwives struggling to care for their patients.

Sixteen researchers representing WaterAid, World Health Organization, UNICEF, the United Nations Population Fund, the London School of Hygiene & Tropical Medicine, the University of Aberdeen and The SoapBox Collaboration, BRAC and BRAC University, and Evidence for Action authored the flagship paper, 'From joint thinking to joint action: A call to action on improving water, sanitation and hygiene for maternal and newborn health.'

The research was funded by the Sanitation and Hygiene Applied Research for Equity (SHARE) Consortium, a five-year initiative funded by the UK Department for International Development and based at the London School of Hygiene & Tropical Medicine.[3]

Yael Velleman, senior policy analyst, sanitation and health, at WaterAid, said: "We have known since Victorian times about the importance of clean water and good hygiene in birth. Yet today tens of thousands of mothers will be giving birth in places where doctors and midwives, if present, do not have access to clean water. The process of giving life should not mean unduly risking death.

"Health agencies and governments have encouraged women to give birth in hospitals and clinics to give them a better chance of surviving complications. But if those environments are dirty, without safe water, basic toilets and a way to keep patients, beds and instruments clean, women are reluctant to seek them out for fear of exposing themselves and their babies to deadly infection.

"As governments work to help women and their babies survive childbirth, they must not neglect these basic building blocks of health care. In coming months, there is a chance to address these desperate needs in new Sustainable Development Goals now under discussion at the UN."

Lenka Benova of the London School of Hygiene & Tropical Medicine, lead author of the companion paper, said: "Nearly 8,000 women in Tanzania die each year in or immediately after childbirth. Sepsis from infection causes at least 10% of these deaths. Nearly half of women, and disproportionately the country's poorest, are giving birth at home, and almost none of these homes have clean water and basic sanitation. But women cannot be expected to go to a health facility to deliver if it is dirty.

"This situation is not limited to Tanzania. What is frustrating is we know infection-related deaths are preventable, with the addition of clean water, basic toilets and good hygiene practice. Our hope is these findings will guide future work on UN development goals and make the provision of these services a priority, when trying to improve the health of new mothers and their babies."

About the UN Millennium Development Goals:

  • In 2000, the United Nations set out eight Millennium Development Goals to achieve by 2015, forming a blueprint for development.

  • There is progress on a goal to reduce the maternal mortality rate by three-quarters; last year, 210 mothers died out of every 100,000 live births - a decline of 45% from 1990. But the maternal mortality ratio in developing regions remains 14 times higher than in developed regions. [4]

  • Newborn mortality is particularly difficult to address. Fewer children under five are dying, from 12.7 million in 1990 to 6.3 million in 2013. [5] But the proportion of newborn deaths is increasing. In 2013 45% of deaths of under fives occurred in the first month of life, according to the WHO.

  • The goal on sanitation is among the most off-track. WaterAid analysis shows Sub-Saharan Africa will not reach its goal, to halve the proportion of people without access to basic sanitation, for 150 years, at present rates of progress.

  • The UN is now negotiating a new set of Sustainable Development Goals to pick up from 2015. WaterAid joins partner organisations in calling for a standalone goal on universal access to water and sanitation in homes, healthcare settings and schools; and the inclusion of water, sanitation and hygiene targets into goals for improving maternal and newborn health.

In Tanzania, WaterAid works in health clinics, schools and homes to improve access to safe water, basic sanitation and hygiene. Interviews and footage from a clinic in Morogoro region in August 2014 show how a regular water supply encouraged women to use the clinic and led to safer, cleaner births.


For footage and interviews from that visit, please see:

For higher quality with transcript:

For photos and case studies, please see:

To read the PLOS Medicine call to action paper, please follow this embargoed link:

To read the PLOS ONE companion paper on Tanzania, please follow this link:

For more information or to arrange interviews please contact:

At WaterAid UK: Carolynne Wheeler, media officer, on 0207 793 4485 or , or or after hours 07887 521 552.

At London School of Hygiene & Tropical Medicine: Jenny Orton or Katie Steels, press office, or +44 (0)207 927 2802.

Notes to editors:


[2] 'A recent World Health Organization rapid assessment of WASH coverage in health facilities in 54 low-income countries found that 38% of these facilities lacked a readily available improved water source,' PLOS Medicine, 'From Joint Thinking to Joint Action' p 2, cited from WHO Landscape report on the status of water, sanitation and hygiene and environmental conditions in healthcare facilities, to be published early 2015.

[3] This article was made possible with UK Aid from the Department of International Development as part of the SHARE Research Consortium. However the views expressed do not necessarily reflect the Department's official policies. The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

[4] 'In 2013 the average maternal mortality ratio in developed countries was just 16 per 100,000 live births compared to 230 in developing countries', PLOS Medicine, 'From Joint Thinking to Joint Action', p 4, cited from WHO et al, Trends in Maternal Mortality, 1990-2013. Also in


About WaterAid:

  • WaterAid's vision is of a world where everyone has access to safe water and sanitation. The international organisation works in 26 countries across Africa, Asia, Central America and the Pacific Region to transform lives by improving access to safe water, hygiene and sanitation in some of the world's poorest communities. Since 1981, WaterAid has reached 21 million people with safe water and, since 2004, 18 million people with sanitation. For more information, visit, follow @WaterAidUK or @Wateraid or @WaterAidPress on Twitter or visit us on Facebook at

  • Around 1,400 children die every day from diseases caused by dirty water and poor sanitation.

  • 748 million people are without safe water, or one in 10 in the world.

  • 2.5 billion people are without adequate sanitation, or 39% of the world's population.

    About the London School of Hygiene & Tropical Medicine:

  • The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with 3,900 students and more than 1,000 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, and was recently cited as the world's leading research-focused graduate school. Our mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice.

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