Haemorrhage and hypertensive disorders like preeclampsia are the leading causes of maternal deaths globally, according to a new study by the World Health Organization (WHO).
Published today in The Lancet Global Health, the study provides the first global update on the causes of maternal deaths in over a decade. The researchers behind the study, including Dr Ursula Gazeley from Oxford Population Health, estimated the global and regional causes of maternal death occurring from 2009 to 2020.
Multiple data sources were used, including the WHO’s Mortality Database, government reports, and journal articles. The model included data from 139,381 maternal deaths in 129 countries.
Haemorrhage – severe heavy bleeding, mostly occurring during or following childbirth – was identified by the study as the leading cause of death, accounting for over a quarter (27%) of maternal deaths globally. Maternal deaths by haemorrhage varied substantially by region, and were highest in sub-Saharan Africa, Western Asia and Northern Africa. The study found that deaths by haemorrhage disproportionately affected low- and middle-income countries, indicating persistent inequities in access to, and the quality of, emergency obstetric care.
Co-author Dr Ursula Gazeley, Postdoctoral Researcher at Oxford Population Health and the Leverhulme Centre for Demographic Science, said ‘Our study highlights the need to improve access to high quality emergency obstetric care, including effective clinical interventions for haemorrhage, particularly in low- and middle-income countries. The timing of most deaths in the postpartum period further underscores the need to improve the provision of early routine postpartum care in many health systems.’
Preeclampsia – a serious condition characterised by high blood pressure – and other hypertensive disorders contributed to 16% of maternal deaths globally, with a higher proportion in Latin America and the Caribbean.
Additional direct obstetric causes of death included complications from spontaneous and induced abortion (8% of maternal deaths), embolism (7%), pregnancy-related infection (7%) and other direct causes (10%). The study found that most maternal deaths from haemorrhage and sepsis occur in the postpartum period.
Co-author Dr Jenny Cresswell, Scientist at WHO, said ‘Often not just one but many interrelated factors contribute to a woman dying during or after pregnancy – preeclampsia for instance can significantly increase the likelihood of haemorrhage as well as other complications that may occur even long after childbirth. A more holistic approach to maternal health has been proven to give women the best chance of a healthy pregnancy and birth, and of enjoying lasting quality of life after delivery – health systems need to be able to support them across different life stages.’
Indirect causes of death were the second largest contributors to maternal mortality, accounting for nearly a quarter (23%) of pregnancy and childbirth-related deaths. These pre-existing health conditions included both infectious and chronic diseases like anaemia, HIV/AIDS, malaria and diabetes. The researchers recommend strengthening the integration of obstetric and non-obstetric care to reduce indirect causes of death.
Dr Pascale Allotey, Director of Sexual and Reproductive Health and Research at WHO as well as the United Nations’ Special Programme on Human Reproduction (HRP), said ‘Understanding why pregnant women and mothers are dying is critical for tackling the world’s lingering maternal mortality crisis and ensuring women have the best possible chances of surviving childbirth. This is also a massive equity issue globally - women everywhere need high quality, evidence-based health care before, during and after delivery, as well as efforts to prevent and treat other underlying conditions that jeopardise their health.’
