Global landscape of maternal hemorrhage mortality: a 40-year analysis based on GBD 2021 study

BACKGROUND: Maternal hemorrhage (MH) is the leading direct cause of global maternal mortality, accounting for over a quarter of all maternal deaths. While significant progress has been made, the decline in MH-related mortality varies widely across regions, reflecting disparities in healthcare access and quality. This study leverages the Global Burden of Disease (GBD) 2021 database to analyze MH mortality trends and inequalities. METHODS: We analyzed MH mortality data from 1982 to 2021 for women aged 15-49. We assessed trends using crude data and age-standardized mortality rates, calculating the estimated annual percentage change (EAPC). We also employed an age-period-cohort (APC) model to examine the effects of age, period, and birth cohort on mortality. Countries were grouped into five categories based on their sociodemographic index (SDI). RESULTS: Globally, the absolute number of MH deaths decreased by 63.13% between 1982 and 2021. High-middle SDI regions showed the greatest improvement with a 91.76% decrease, while low-SDI regions had the most modest progress at 21.57%. By 2021, Nigeria, India, and Pakistan had the highest absolute number of deaths, while Sierra Leone, Chad, and Niger had the highest age-standardized mortality rates. The APC analysis revealed a persistent disparity: successive generations in low-SDI regions still face substantially higher risks compared to their counterparts in high-SDI settings. CONCLUSION: Our findings reveal significant global progress in reducing MH mortality, but also a growing health disparity, with the burden increasingly concentrated in low-SDI countries. This highlights the need for targeted policies that strengthen healthcare systems in vulnerable regions to achieve global equity in maternal health.