Maternal mortality from obstetric hemorrhage in Brazil: a 10-year analysis (2015 to 2024)

Obstetric hemorrhage is a leading preventable cause of maternal mortality (MM) worldwide. This study described MM due to obstetric hemorrhage in Brazil and examined temporal trends and associations with maternal age, skin color, educational level, and geographic region.

We conducted a nationwide population-based cross-sectional study using data from the Mortality Information System (SIM) and Live Birth Information System (SINASC), including 2,985 hemorrhage-related maternal deaths recorded between 2015 and 2024. Causes were classified as first-half pregnancy hemorrhage, placental/intrapartum hemorrhage, or postpartum hemorrhage.

Overall, hemorrhage accounted for 17.2% of maternal deaths (MMRH 10.86 per 100,000 live births), with no significant temporal change during the study period. Postpartum hemorrhage accounted for 38.96% of deaths, followed by placental/intrapartum hemorrhage (33.74%) and first-half pregnancy hemorrhage (27.30%). Overall, hemorrhage accounted for 17.2% of maternal deaths (MMRH 10.86 per 100,000 live births), with no significant temporal change during the study period. Marked disparities were observed across population groups. Indigenous and Black women had 2.87-fold (95% CI 2.23-3.70) and 1.66-fold (95% CI 1.44-1.92) higher prevalence of hemorrhagic maternal death than White women, respectively. Women aged ≥40 years had nearly fourfold higher risk than those aged 20-29 years (PR 3.90; 95% CI 3.38-4.51), while women with no formal education had almost tenfold higher risk than those with ≥12 years of education (PR 9.68; 95% CI 7.46-12.56). The North region showed the highest excess risk (PR 1.84; 95% CI 1.56-2.15).

Reducing hemorrhagic maternal mortality in Brazil requires strengthening evidence-based hemorrhage care while addressing persistent racial, educational, and regional inequalities.