Maternal Mortality: Global Trends and Disparities in the 21st Century

GBD 2021, a Global Burden of Disease analysis synthesizing vital-registration, survey, and modelled data across countries from 1990–2021, shows global maternal mortality fell from 260.02 to 147.77 deaths per 100,000 live births between 1990 and 2021 — a substantial decline that nonetheless remains well above SDG targets. Continued progress is evident, but the remaining gap to international goals signals persistent unmet needs in many settings and requires focused clinical and public-health action.

Estimates, derived from pooled vital-registration data, household surveys and modelled adjustments, reveal wide regional variation: low-SDI regions reached 286.49 deaths per 100,000 live births while high-SDI areas registered near 17.76 per 100,000 — an order-of-magnitude difference that underscores unequal access to obstetric services and referral capacity. These contrasts reflect differences in health-system capacity, socioeconomic constraints, and availability of emergency obstetric care; targeting resources to high-burden areas is essential to reduce inequities in maternal survival.

Socioeconomic barriers, limited access to quality obstetric care, and health-system constraints are dominant drivers consistent with the observed geographic disparities. Age-specific mortality follows a U-shaped curve with peaks at 10–19 and 35–49 years, reflecting biologic vulnerability in adolescents and greater comorbidity and obstetric complexity in older reproductive-age individuals. These intersecting physiologic and sociostructural factors — early pregnancy, constrained care-seeking, and chronic disease burden — elevate risk. Antenatal and postpartum services should incorporate age-specific risk screening and timely interventions.

Robust surveillance and strengthened civil registration and vital statistics are essential to track trends accurately and direct resources where they will have greatest impact. Achieving SDG targets depends on closing data gaps and expanding equitable maternal-health coverage so that measurement aligns with programmatic needs. Improved data systems are a precondition for accountable investment and scaled interventions.

Clinically, the highest burden is concentrated in low-SDI regions and among adolescents and older reproductive-age individuals; frontline services should prioritize antenatal risk identification, timely emergency obstetric care, and structured postpartum follow-up. Expanding emergency obstetric capacity, ensuring reliable supplies (blood, uterotonics, antihypertensives), and strengthening referral pathways will address leading causes such as haemorrhage and hypertensive disorders. These operational priorities are essential steps toward meeting international maternal-health targets.