AbstractAlmost all maternal and child deaths represent merely the endpoint of the ‘road to death’ — a combination of factors that include high‐risk pregnancy, socioeconomic disadvantage and inadequate health care. Unregulated fertility is the underlying cause of most high‐risk pregnancies. They are: unwanted; in mothers younger than 20 or older than 35; closely spaced; and in women who already have several children. The resulting morbidity and mortality create a cycle of further disadvantage, further increases in child mortality and further high‐risk pregnancies. Family planning is the single most important exit from the ‘road to death.’ Over the past 40 years it has contributed to the worldwide reduction in child mortality, and for every 100 women provided with family planning, a woman's life is saved.