Closing the Justice Gap in Maternal Health

Abstract

Introduction:

The United Nations 70th Session of the Commission on the Status of Women (CSW70) prioritized justice for all women and girls. Maternal health is central to this agenda, as preventable maternal morbidity and mortality reflect systemic inequities in societal and health systems worldwide.

Discussion:

This article discusses maternal health as a fundamental justice for all women and girls. Advancing this agenda requires coordinated policy action, workforce support, and strong accountability mechanisms. Evidence-based strategies for effective maternal health include midwifery-led care, maternal mortality review systems, and community-based models. CSW70 can further integrate maternal health into global justice frameworks.

Recommendations:

Policy recommendations include multi-sector collaboration, stronger national accountability, and investments in culturally appropriate care. Nurses, midwives, and birth support professionals are key stakeholders in shaping policies to advance maternal health justice. Recognizing maternal health as a human right is essential to advancing equity and justice for all women and girls globally.

Introduction

The United Nations 70th Session of the Commission on the Status of Women (CSW70) convened governments, civil societies, and national agencies around the priority theme of ensuring and strengthening access to justice for all women and girls. Discussions emphasized the current status on legal systems, gender-based violence, technology-facilitated harms, artificial intelligence, and women’s freedom to participate in policy and leadership. Collectively, these discussions reflected a growing global consensus that justice must be responsive, inclusive, and grounded in the reality of women’s lived experiences.

Maternal health encompasses the continuum of care during pregnancy, childbirth, and postpartum. Preventable morbidities and mortality during this care continuum continue being underrecognized and undertreated (World Health Organization [WHO], 2025). The lack of maternal health care has deprived many women of essential care to prevent maternal morbidity (e.g., preeclampsia, depression) and mortality. Women’s health during reproduction is not merely a clinical concern but a fundamental human right (WHO, 2025). Maternal health as a human right is critical in ensuring access to justice for all women and girls.

CSW70 represents a global and unified effort to influence and shape global policy discourse, funding priorities, and accountability expectations. It offers a platform to align maternal health within the justice-oriented frameworks. Policymakers and health leaders play a critical role in ensuring maternal health care is responsive to women’s diverse social, economic, and political contexts.

Maternal Health as a Justice Issue

Maternal health is a sentinel indicator of social equity and health system performance. Maternal mortality and morbidity rates remain unacceptably high primarily in low-resource settings, as well as in some high-resource settings around the world. Maternal mortality and morbidity remain disproportionately high among specific groups such as Indigenous, immigrant, and women of color, low-income women, and mothers in rural settings (Anderson & Roberts, 2023; Fu, 2025).

Maternal morbidity results in long-term physical, psychological, and socioeconomic consequences for women and families. Preventable maternal morbidities reflect systemic failures rather than individual risk alone (WHO, 2025). Justice in maternal health entails access to timely, high-quality, respectful care supported by health systems that demonstrate accountability for system failures. Culturally appropriate care during pregnancy, childbirth, and postpartum recovery has lifelong benefits for women’s health and well-being (Cannon, 2024).

Structural Barriers in Maternal Health Systems

Structural characteristics of maternal health systems contribute to persistent inequities. Care fragmentation across prenatal, intrapartum, and postpartum services limits continuity of care (United Nations Population Fund [UNFPA], 2024; WHO, 2025). This discontinuity disproportionately affects women with complex medical or social needs and undermines early identification of risk (UNFPA, 2024).

Gaps in health care coverage and maternal leave policies further restrict access to care during a time of heightened vulnerability, placing women at risk of death and economic disadvantage (UNFPA, 2024; WHO, 2025). Health care coverage and maternal leave policy gaps further exacerbate injustice. Health coverage during pregnancy and the postpartum period, along with adequate paid or unpaid maternal leave, is often insufficient, resulting in uneven access to adequate maternal care. Many women do not have access to health care immediately after birth even though evidence demonstrates that a substantial proportion of maternal deaths occur in the postpartum period (WHO, 2025).

Workforce shortages among nurses, midwives, and obstetric providers exacerbate these challenges, particularly in rural and underserved areas. Community-based care models, including midwifery-led practices, doula support, and community-health workers, remain underfunded and inconsistently integrated into health systems despite evidence of improved outcomes and patient experiences (Gonzales & Balabagno, 2026; Gupta & Khan, 2024). Reorganizing care around continuity can yield measurable maternal benefits (WHO, 2025).

Policy Impact of CSW70

CSW70 advanced justice frameworks centered on accountability, prevention, and systems change, creating a strong foundation for recognizing the full range of women’s rights across the lifespan. Within this context, maternal health initiatives discussed in side events offered important forums on pregnancy, childbirth, and postpartum care as essential to women’s right, dignity, equity, and well-being. These discussions underscored the growing recognition that maternal health is not a private issue but a social justice and public responsibility. Nursing and midwifery professionals contribute to justice-oriented policy making and implementation by providing essential expertise in systems design, cultural support, continuity of care, and community-centered support (Gonzales & Balabagno, 2026). Continued engagement by maternal health advocates, nurses, and midwives ensures that pregnancy and childbirth remain visible within global justice conversations. Nurses and midwives contribute essential expertise in continuity of care, culturally responsive practice, and community engagement. Through sustained advocacy and collaboration, these stakeholders ensure that maternal health remains central to justice for women and girls.

Policy Gaps

Several policy gaps limit progress toward maternal health justice across countries. In many settings, the absence of a unified maternal health justice framework results in fragmented care and weakened accountability mechanisms. In countries with mandated notification and systematic review of every maternal death, followed by corrective action, improved outcomes demonstrate how preventable deaths can be transformed into learning, accountability, and targeted quality-improvement efforts.

Standardized clinical tools, such as evidence-based checklists used during labor, delivery, and postpartum care, improve maternal health when paired with coaching and system support. These approaches improve adherence to lifesaving practices in high-pressure clinical environments (Tolu et al., 2020). Investment gaps persist in postpartum care, prevention strategies, and economic protections. Economic protections, such as paid maternal leave, job security, and income support, are increasingly viewed as health justice imperatives. Such economic protections are often absent or insufficient despite strong evidence linking these protections to improved maternal outcomes. In addition, alignment between country-level maternal health strategies and international gender equality commitments remains limited.

Policy Recommendations

Multi-Sector Collaboration

Effective approaches across countries demonstrate the value of integrating maternal health within gender-based violence, economic security, and social protection frameworks. The United Nations and other multisectoral forums should explicitly include maternal health within global justice and accountability agendas.

Nation-Level Actions

Countries should establish maternal mortality and morbidity as core performance indicators and ensure continuity of care through standardized postpartum coverage. Expanding midwifery-led models of care and linking review findings to policy and funding decisions are critical steps.

Including nursing and midwifery stakeholders is imperative in shaping maternal health policies and systems design.

Local-Level Actions

At the local level, strengthening maternal mortality review boards and investing in culturally responsive, community-based care improves outcomes. Addressing workforce shortages and supporting culturally appropriate care models enhance trust and access in underserved populations. Targeted strategies to address workforce shortages and support culturally congruent care models have demonstrated effectiveness in improving continuity, experience of care, and maternal health outcomes.

Implications for Nursing and Health Professionals

Nurses and midwives are in a critical position to advance maternal health justice. Beyond clinical care, they serve as advocates, educators, and system leaders. Their trusted role positions them to promote health equity and culturally appropriate care. Education, research, and advocacy grounded in transcultural nursing are essential for informing equitable policies.

Professional societies, including the Transcultural Nursing Society, play a vital role in advocating maternal health within national and global policy discourses and supporting nurses’ engagement in justice-oriented leadership.

Conclusion

CSW70 highlighted maternal health through civil engagement, offering the opportunity for integrating maternal health in global justice frameworks. Recognizing maternal health as a fundamental human right strengthens efforts to achieve equity for all women and girls. Advancing maternal health justice requires coordinated policy, sustained investment, and accountability across systems. Nurses and midwives are essential stakeholders of maternal health, and it is imperative to include nurses and midwives as key partners in the process of shaping maternal health policies at global, national, and local levels.