Haemorrhage and hypertensive disorders like pre-eclampsia are the leading causes of maternal deaths globally, according to a study released this week by the World Health Organisation (WHO) and published in The Lancet Global Health.
The researchers said these conditions were responsible for around 80 000 and 50 000 fatalities respectively in 2020, the last year for which published estimates are available, highlighting that many women still lack access to lifesaving treatments and effective care during and after pregnancy and birth.
The study is the WHO’s first global update on the causes of maternal deaths since the United Nations’ Sustainable Development Goals were adopted in 2015.
In addition to outlining the major direct obstetric causes, it shows that other conditions, including both infectious and chronic diseases like HIV/Aids, malaria, anaemia and diabetes, underpin nearly a quarter (23%) of pregnancy and childbirth-related mortality. These conditions, which often go undetected or untreated until major complications occur, exacerbate risk and complicate pregnancies for millions of women around the world.
“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,” said Dr Pascale Allotey, director of sexual and reproductive health and research at the WHO as well as the UN’s Special Programme on Human Reproduction (HRP).
“This is also a massive equity issue globally – women everywhere need high quality, evidence-based healthcare before, during and after delivery, as well as efforts to prevent and treat other underlying conditions that jeopardise their health.”
In 2020, there were an estimated 287 000 maternal deaths in total – equivalent to one death every two minutes.
The study reports that haemorrhage, mostly occurring during or after childbirth, is responsible for nearly a third (27%) of maternal mortality, with pre-eclampsia and other hypertensive disorders contributing to an additional 16%. Pre-eclampsia is a serious condition characterised by high blood pressure that can lead to haemorrhage, strokes, organ failures and seizures if left untreated or treated too late.
Other direct causes include: sepsis and infections, pulmonary embolism, complications from spontaneous and induced abortions – including miscarriage, ectopic pregnancies and issues relating to unsafe abortions – and anaesthetic complications and injuries that occur during childbirth.
The findings highlight the need to strengthen key aspects of maternity care, including antenatal services that detect risks early in pregnancy and prevent severe complications; lifesaving obstetrics that can manage critical birth-related emergencies like haemorrhage or embolism, and postnatal care.
Most maternal deaths occur during or shortly after childbirth, making this a critical window to save lives. However, around a third of women – primarily in lower income countries – still do not receive essential postnatal checks in the first days after birth.
At a population level, broader preventive interventions could help reduce the prevalence of underlying health conditions, like non-communicable diseases and malnutrition, that increase women’s risks.
The study draws on national data that is reported to WHO, as well as peer-reviewed studies. For some causes, data remains limited. In particular, the authors call for more data on maternal suicide, which is currently available for only 12 countries. In addition, most countries do not report on late maternal deaths (those that occur in the year after childbirth), although several conditions can lead to risks lasting much beyond the birth itself.
After childbirth, many women struggle to access follow-up care, including mental health support.
In 2024, the WHO and partners launched a global Roadmap for Postpartum Haemorrhage, which outlines key priorities for tackling this major cause of maternal death. In the same year, the World Health Assembly’s 194 countries passed a Resolution committing to strengthen quality care before, during and after childbirth.
Study details
Global and regional causes of maternal deaths 2009–20: a WHO systematic analysis
Jenny Cresswell, Monica Alexander, Michael Chong et al.
Pubished in The Lancet Global Health on 7 March 2025
Summary
Background
Maternal mortality is not on track to meet Sustainable Development Goal (SDG) target 3.1 of a global maternal mortality ratio below 70 per 100 000 livebirths by 2030. Updated evidence on causes of death is needed to accelerate progress.
Methods
We conducted a multi-strategy systematic review to identify causes of maternal deaths occurring in 2009–20. Data sources included civil registration and vital statistics systems data from the WHO Mortality Database, reports published by Member States, and national and subnational journal articles identified via bibliographic databases. We used a Bayesian hierarchical model to estimate the maternal cause of death distribution by SDG regions and worldwide. Given the paucity of data on maternal suicide and late maternal deaths occurring beyond 42 days postpartum, additional analyses were conducted to estimate the proportion of maternal deaths from suicide and the ratio of maternal to late maternal deaths (all cause).
Findings
Globally, the most common cause of maternal death was haemorrhage (27%; 80% uncertainty interval 22–32), followed by indirect obstetric deaths (23%, 18–30), and hypertensive disorders (16%, 14–19). The proportion of haemorrhage deaths varied substantially by region and was highest in sub-Saharan Africa and Western Asia and Northern Africa. The proportion of maternal deaths from hypertensive disorders was highest in Latin America and the Caribbean. Most maternal deaths from haemorrhage and sepsis occurred during the postpartum period. Only 12 countries recorded one or more maternal suicides; of those countries, the proportion of deaths from suicide ranged from below 1% to 26% of maternal deaths. For countries reporting at least one late maternal death (ie, deaths that occur more than 42 days but less than 1 year after the termination of pregnancy), the ratio of late maternal deaths to maternal deaths up to 42 days ranged from <0·01 to 0·07.
Interpretation
Haemorrhage remains the leading cause of death, despite the existence of effective clinical interventions, emphasising the need for improved access to quality health care. The timing of most deaths in the postpartum period demands renewed commitment to improving the provision of postpartum care in addition to intrapartum care. Indirect causes of death require health system approaches to integrate obstetric and non-obstetric care.
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