Global, regional and national burden of maternal haemorrhage (2000-2021) and projections to 2050 in 204 countries and territories

Objective To estimate the global, regional and national burden of maternal haemorrhage (2000, 2021) and its 2050 projections in 204 countries and territories.

Design This study systematic analysis of the burden of maternal haemorrhage sourced data from the Global Burden of Disease (GBD) 2021 study. We estimated the incidence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs) and years of life lost (YLLs) due to maternal haemorrhage. Changes in the burden from 2000 to 2021 were computed using AAPC. To detect statistically notable changes in the trends of maternal haemorrhage metrics between 2000 and 2021, Joinpoint regression analysis using the Joinpoint Regression Programme was conducted. We also projected mortality rates, YLDs and YLLs through to 2050 using maps and trends generated by the GBD Foresight visualisation tool.

Results Globally, the incidence of maternal haemorrhage among women aged 15, 49 years declined from 881.98 per 100 000 reproductive aged women (95% uncertainty interval (UI) 687.01 to, 1150.23) in 2000 to 714.00 (95% UI 556.97 o t908.54) in 2021, with an average annual percentage change (AAPC) of, 0.91 (, 1.37 to, 0.49). Similar downward trends were observed for maternal deaths, DALYs, YLDs and YLLs attributable to maternal haemorrhage, with AAPCs of, 3.78 (, 4.39 to, 3.18), 4.68 (, 4.83 to, 4.55), 1.21 (, 1.54 to, 0.89) and, 4.80 (, 5.10 to, 4.52), respectively. Sub-Saharan Africa, particularly Western Sub-Saharan Africa, recorded the highest burden in 2021, which is almost 300 times higher than in Western Europe. Elevated rates of mortality, DALYs and YLDs were also evident in Sierra Leone, Chad, Niger, Mali, Nigeria, Burkina Faso, Central African Republic, Somalia and South Sudan in 2021 and projections for 2050. However, the high-income Asia Pacific region had the lowest incidence, DALYs and YLDs at 151.32 (109.63, 203.68), 2.21 (1.72, 2.86) and 0.87 (0.46, 1.38) per 1 00 000 women, respectively. Australasia recorded the lowest maternal death count and YLLs attributed to maternal haemorrhage at 0.69 (0.50, 0.90) and 0.56 (0.41, 0.74) per 1 00 000 women, respectively.

Conclusion While the global burden of maternal haemorrhage has declined over time, significant regional and national inequities persist. Even though the 2050 projections show improvement in the burden of maternal haemorrhage, there is also regional and national variation in the rate of decrease in maternal haemorrhage burden. Targeted, context-specific interventions are urgently needed to reduce maternal haemorrhage-related mortality and morbidity.