In 2020, approximately 287,000 women worldwide died from pregnancy- or childbirth-related complications, equivalent to one death every 2 minutes. Hemorrhage and hypertensive disorders, such as preeclampsia, remain the leading causes of maternal mortality globally, highlighting persistent gaps in access to effective care in low-income countries.
These findings come from a new study published in The Lancet Global Health and released by the World Health Organization (WHO). The study provides the first major update on the causes of maternal mortality since the adoption of the United Nations Sustainable Development Goals (SDGs) in 2015. The analysis indicated that the world remains far from achieving the SDG target of fewer than 70 maternal deaths per 100,000 live births by 2030.
In 2020, the global maternal mortality ratio was 223 deaths per 100,000 live births. The WHO defines maternal mortality as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.
Geographic Disparities
This study conducted a multimethod systematic review of maternal deaths between 2009 and 2020 and revealed significant geographical disparities, with 95% of deaths occurring in low- and middle-income countries or vulnerable healthcare settings.
“Understanding why pregnant women and mothers are dying is critical to addressing the world’s persistent maternal mortality crisis and ensuring they have the best possible chance of surviving childbirth,” said Pascale Allotey, PhD, director of WHO’s Department of Sexual and Reproductive Health and Research, which includes the United Nations Development Programme/United Nations Population Fund/United Nations Children’s Fund/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction.
“This is also a major global equity issue. Women everywhere need high-quality, evidence-based healthcare before, during, and after childbirth, as well as efforts to prevent and manage underlying conditions that compromise their health,” she added.
Causes of Death
The study classified maternal deaths according to the WHO International Classification of Diseases-Maternal Mortality and grouped them as follows:
- Hemorrhage
- Hypertensive disorders, such as preeclampsia
- Sepsis and pregnancy-related infections
- Embolism
- Complications from abortion, including spontaneous and induced abortions, as well as ectopic pregnancy
- Other direct causes, such as anesthetic complications
- Indirect causes, such as preexisting medical conditions exacerbated by pregnancy
Overall, hemorrhage, primarily occurring during or after childbirth, accounted for nearly one third (27%) of maternal deaths. Indirect obstetric deaths were 23%, followed by hypertensive disorders (16%), abortion-related complications (8%), pregnancy-related infections (7%), embolism (7%), and other direct causes (10%).
Regional Variations
Significant regional differences were observed in the incidence of hemorrhage-related deaths. In West Asia, North Africa, and sub-Saharan Africa, hemorrhage accounted for 29% and 28% of maternal deaths, respectively. In contrast, it was responsible for 15% of maternal deaths in Australia, New Zealand, North America, and Europe. Given the higher overall maternal mortality burden in regions where hemorrhage-related deaths are more common, the absolute number of deaths remains high.
In Latin America and the Caribbean, hypertensive disorders were the leading cause of maternal mortality (22%), whereas hemorrhage accounted for 17%. These proportions were notably higher compared with Australia and New Zealand, and North America and Europe, where hypertensive disorders accounted for 10% and 12% of maternal deaths, respectively.
“Increases in the proportion of women delivering in healthcare facilities have not been sufficient to reduce deaths from hemorrhage or hypertensive disorders of pregnancy,” the study highlighted. “For hypertensive disorders, increases in the coverage of antenatal care potentially have not corresponded to adequate implementation of preventive strategies.”
The study also emphasized the role of other health conditions, including infectious and chronic diseases such as HIV/AIDS, malaria, anemia, and diabetes, which accounted for 23% of pregnancy- and childbirth-related deaths. Often undiagnosed and untreated, these conditions further elevate the risk for complications, compounding the challenges in reducing maternal mortality despite increased access to healthcare facilities.
“Often, it is not just one factor but several interconnected factors that contribute to a woman’s death during or after pregnancy — preeclampsia, for example, can significantly increase the risk of hemorrhage, as well as other complications that may arise long after delivery,” said Jenny Cresswell, PhD, a WHO scientist and one of the study’s authors.
The study was based on national data reported to the WHO and peer-reviewed literature. The authors caution that the data for some causes of maternal mortality remain limited. They highlighted the need for more research on maternal suicide, for which data are currently available from only 12 countries.
This story was translated from Medscape’s Portuguese edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Source: Medscape
