Declining but uneven: global evolution of maternal hemorrhage burden and its future trajectory

Maternal hemorrhage is a leading cause of maternal morbidity and mortality worldwide, with significant regional disparities. This study utilizes the most recent Global Burden of Disease (GBD) 2021 data to examine global and regional trends in maternal hemorrhage from 1990 to 2021.

We analyzed the incidence, mortality, and disability-adjusted life years (DALYs) attributable to maternal hemorrhage across 204 countries and territories. We calculated the Estimated Annual Percentage Change (EAPC) for key indicators and projected future trends using Bayesian age-period-cohort models.

From 1990 to 2021, global maternal hemorrhage incidence declined from 14.17 million to 13.96 million cases, and age-standardized incidence rate (ASIR) decreased from 245.34 to 176.89 per 100,000 (EAPC: -0.835 %), with particularly high rates in Central and Western Sub-Saharan Africa. DALYs attributed to maternal hemorrhage dropped from 7.1 million to 2.96 million, with the age-standardized DALYs rate (ASDR) falling from 125.29 to 37.47 per 100,000 (EAPC: -3.975 %). Mortality also decreased from 114,112 to 46,874 deaths, and the age-standardized mortality rate (ASMR) declined from 2.04 to 0.59 per 100,000 (EAPC: -4.055 %), with the largest reductions in East Asia and South Asia. Regions with lower socio-demographic index experienced high incidence, DALYs, and mortality rates. Projections to 2050 suggest a continued global decline in all indicators.

Despite overall reductions in the global burden of maternal hemorrhage, significant regional disparities persist, particularly in low-resource settings. Targeted interventions in high-burden regions, such as Sub-Saharan Africa, are crucial to further reduce maternal morbidity and mortality.