Haemorrhage (heavy profuse bleeding) and hypertensive diseases such as pre-eclampsia are the leading causes of maternal death worldwide, according to a new study published by the World Health Organization (WHO). These conditions are responsible for an estimated 80,000 and 50,000 deaths respectively in 2020 - the latest year for which published estimates are available - highlighting that many women still lack access to life-saving treatment and effective care during and after pregnancy and childbirth.

The study is WHO's first global update on the causes of maternal mortality since the adoption of the UN Sustainable Development Goals in 2015. In addition to outlining the main direct obstetric causes, it shows that other health conditions, including infectious and chronic diseases such as HIV/AIDS, malaria, anaemias and diabetes, account for almost a quarter (23%) of pregnancy and childbirth-related deaths. These conditions, which often go undetected or untreated until serious complications occur, increase the risk and complicate pregnancy for millions of women worldwide.

"Understanding the reasons why pregnant women and mothers die is critical to tackling the world's long-standing maternal mortality crisis and ensuring that women have the best possible chance of surviving childbirth," says Dr Pascal Alotti, Director of the Division of Sexual and Reproductive Health and Research at WHO as well as the UN Special Programme on Human Reproduction (HPHR). "This is also a huge equity issue globally - women everywhere need high-quality, evidence-based health care before, during and after childbirth, as well as efforts to prevent and treat other major diseases that threaten their health."

In 2020, there were a total of 287,000 maternal deaths - that equates to one death every two minutes. This new WHO study reports that haemorrhage - most commonly occurring during or after childbirth - is responsible for almost a third (27%) of maternal deaths, with pre-eclampsia and other hypertensive diseases contributing a further 16%. Pre-eclampsia is a serious condition characterised by high blood pressure that can lead to haemorrhage, strokes, organ failure and seizures if left untreated or treated too late.

Other direct causes include: sepsis and infections; pulmonary embolism; complications from miscarriages and induced abortions - including miscarriage, ectopic pregnancy and problems associated with unsafe abortions - and complications from anaesthesia 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; life-saving obstetric services that can deal with critical birth-related emergencies, such as haemorrhage or embolism; and postnatal care. Most maternal deaths occur during or shortly after childbirth, making this period critical for saving lives. Yet about one-third of women - mostly in lower-income countries - still do not receive basic postnatal checkups in the first days after childbirth. At the population level, broader preventive interventions could help reduce the prevalence of underlying health conditions - such as non-communicable diseases and malnutrition - that increase women's risks.

The study is based on national data reported to WHO as well as peer-reviewed studies. For some causes, data are 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 occurring in the year after birth), although several conditions can lead to risks continuing well beyond the birth itself. After birth, many women struggle to access follow-up care, including mental health support.

WHO is working to strengthen access to high-quality, human rights-respecting services across the continuum of pregnancy, childbirth and postnatal care through evidence-based research and guidance. In 2024, WHO and partners launched a global roadmap on postpartum haemorrhage that outlines key priorities for addressing this major cause of maternal mortality.

In the same year, the 194 countries of the World Health Assembly adopted a Resolution committing to strengthen quality care before, during and after childbirth. To spur action, World Health Day in 2025, which marks the five-year anniversary of the Sustainable Development Goals deadline, will be dedicated to maternal and newborn health.

The study, entitled "Global and regional causes of maternal mortality 2009-2020: a systematic analysis by WHO", updates a previous analysis conducted in 2014, which covered the period 2003-2009. Haemorrhage was also responsible for the largest proportion of deaths in the previous analysis (27%).

New estimates of the total number of maternal deaths will be published in April 2025, incorporating data at global, regional and national levels, covering the period 2000-2023 | BGNES