Malnutrition and lack of access to healthcare results in 9,000 deaths of Tanzanian women during childbirth each year, the U.N. said Wednesday.

Sixty percent of all Tanzanian mothers deliver at home, many without the help of a skilled birth attendant, which puts both the lives of the mother and the child at risk, experts say.

“There are 529 deaths in every 100,000 live births,” Rodney Phillips, U.N. Children’s Fund representative in Tanzania, told Reuters in an interview.

In the impoverished country of 35 million, where more than 50 percent of the population lives on less than a dollar a day, the average woman bears six children.

UNICEF said the country lacks a functioning social welfare program, a hospital referral system or working antenatal care clinics. Pregnant women, mostly living in rural areas, are expected to continue performing manual labor. They do not get quality food or rest despite being physically exhausted.

“Here you have the case of a woman, she is malnourished, she is fatigued from work, she goes only once to an antenatal clinic, the health worker is unable to identify a complicated pregnancy, there is no referral system. It’s a formula for disaster,” he said.

“It’s a complex mix of factors that end up with a dead mother. Now add to that the underlying HIV situation,” which further worsens the situation, he said.

According to the U.N. statistics, between 12 and 15 percent of adults are infected with HIV in Tanzania. One of the U.N. Millennium Development Goals is to improve maternal health and to reduce maternal mortality ratio by three quarters by 2015.

“We are moving that way but whether we reach the goal is another question. This area of maternal mortality is too complex and it requires building up of primary health infrastructure, better-trained staff, and a hospital referral system. You are talking about major investment in infrastructure and training and this doesn’t come cheap,” he said.

UNICEF estimates Tanzania has between 1.9 million to 2.5 million orphans, half of whom have lost one or both parents to AIDS.