Report on the Global Burden of Maternal Disorders (1990-2021) in the Context of Sustainable Development Goals

Global Progress Towards SDG 3.1: Maternal Mortality Reduction

An analysis of Global Burden of Disease (GBD) data from 1990 to 2021 indicates significant, albeit incomplete, progress towards Sustainable Development Goal 3 (Good Health and Well-being), particularly Target 3.1, which aims to reduce the global maternal mortality ratio. While substantial gains have been made, persistent challenges require continued focus to achieve the 2030 agenda.

• Maternal Deaths: The absolute number of global maternal deaths decreased from 342,498 in 1990 to 191,152 in 2021, marking an average annual decline of 3.1%.
• Maternal Mortality Rate: The age-standardized maternal mortality rate saw a significant reduction of approximately 60%, falling from 12.452 per 100,000 in 1990 to 4.869 per 100,000 in 2021.
• Disability-Adjusted Life Years (DALYs): The overall health burden, measured in DALYs, also declined from 21.8 million in 1990 to 12.3 million in 2021. This reduction in both mortality and disability signifies an improvement in overall health outcomes for mothers, aligning with the broader aims of SDG 3.

Principal Causes of Maternal Mortality and Implications for SDG 3.8

Achieving universal health coverage (SDG Target 3.8) requires addressing the specific clinical challenges that lead to maternal mortality. The primary causes of maternal death, while decreasing in number, remain consistent, highlighting areas where health systems must be strengthened.

Leading Causes of Maternal Deaths

1. Maternal Hemorrhage: Remained the leading cause, decreasing from 114,113 deaths in 1990 to 46,874 in 2021.
2. Hypertensive Disorders: The second leading cause, with deaths falling from 53,894 to 38,147.
3. Abortion and Miscarriage: The third leading cause, with deaths reduced from 47,506 to 16,706.

Together, these three causes accounted for approximately 63% of all maternal deaths in 2021. While the significant decline in deaths from hemorrhage (EAPC of -4.06%) and abortion/miscarriage (EAPC of -4.67%) points to successful interventions, a concerning trend was observed for ectopic pregnancy. Deaths from this cause increased slightly, and the age-standardized death rate stagnated, indicating a critical gap in early detection and emergency obstetric care that must be addressed to fulfill the promise of SDG 3.8.

Socio-Demographic and Regional Disparities: A Challenge for SDG 10

The data reveal stark inequalities in maternal health outcomes, underscoring the importance of SDG 10 (Reduced Inequalities). The Socio-demographic Index (SDI) is a strong negative correlate with maternal mortality, meaning that as a region’s development level increases, maternal mortality and DALY rates decrease significantly.

• Low-SDI Regions: In 2021, these regions recorded the highest burden, with 19.43 deaths and 1191.5 DALYs per 100,000 people.
• High-SDI Regions: These regions had the lowest burden, with 0.358 deaths and 28.48 DALYs per 100,000 people.

Regionally, Sub-Saharan Africa and South Asia consistently bear the highest burden of maternal mortality and DALYs. Although South Asia has demonstrated a remarkable rate of decline (EAPC for deaths of -6.34%), these regions remain the epicenters of the global maternal health crisis. Conversely, a troubling increase in maternal mortality was noted in high-income North America and the Caribbean, driven by deaths from obstructed labor, uterine rupture, and ectopic pregnancy. This finding indicates that no region is immune to challenges and that achieving SDG 10 requires tailored strategies that address inequalities both between and within countries.

Demographic Analysis and Age-Specific Risks

Understanding the demographic drivers of maternal mortality is essential for targeting interventions effectively, a key component of both SDG 3 and SDG 5 (Gender Equality).

• Age-Specific Risk: The highest number of maternal deaths globally occurs in the 20-24 age group. However, in higher-income regions, this peak shifts to the 25-34 age range.
• Decomposition Analysis: Improvements in epidemiological factors (e.g., better healthcare, treatments) were the primary driver of the global reduction in maternal deaths. However, this progress was partially offset by population growth, which increased the at-risk population.
• Age-Period-Cohort (APC) Model: The model confirms that age is a dominant factor in mortality risk. It also reveals a significant cohort effect, where women born in later generations (1980-2000) face markedly lower mortality risks than those born earlier (1940-1960), reflecting systemic improvements in healthcare over time.

In conclusion, while epidemiological advancements have driven substantial progress toward global maternal health goals, this progress is threatened by population growth and undermined by profound socio-demographic and regional inequalities. Achieving the SDG targets by 2030 will require a renewed focus on strengthening health systems, ensuring universal access to quality care, and addressing the specific needs of the most vulnerable populations in all regions.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  This is the primary SDG addressed. The entire article is a detailed analysis of maternal health, focusing on trends in maternal mortality and the burden of maternal disorders. It directly discusses health outcomes, causes of death, and the overall health status of mothers globally, which is the core of SDG 3.

• SDG 5: Gender Equality

  Maternal health is a critical component of gender equality. The article’s focus on reducing maternal mortality and morbidity from causes like unsafe abortion, hemorrhage, and obstructed labor directly relates to empowering women and ensuring their health and well-being, which is fundamental to achieving gender equality.

• SDG 10: Reduced Inequalities

  The article explicitly highlights significant disparities in maternal health outcomes based on socio-economic and geographical factors. It compares maternal mortality and DALY rates across different Socio-demographic Index (SDI) levels and regions, noting that “sub-Saharan Africa and South Asia consistently recorded the highest age-standardized maternal mortality and DALY rates.” This analysis directly addresses the goal of reducing inequalities within and among countries.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.

   The article is centered on this target. It provides extensive data on the reduction of maternal mortality, stating that the “age-standardized maternal mortality rate dropped from 12.452 per 100,000… to 4.869 per 100,000 in 2021, representing a reduction of approximately 60%.” This directly measures progress toward the global goal of reducing maternal deaths.

2. Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

   The article identifies “hypertensive disorders” as one of the top three leading causes of maternal death. It notes that deaths from this cause decreased from 53,894 in 1990 to 38,147 in 2021. Since hypertensive disorders are a non-communicable disease, tracking and reducing mortality from this cause contributes to this target.

3. Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights.

   The article discusses several causes of maternal death that are directly linked to the lack of sexual and reproductive healthcare. It highlights significant reductions in deaths from “maternal abortion and miscarriage” and “obstructed labor and uterine rupture.” Progress in these areas implies improved access to services like safe abortion, family planning, and skilled birth attendance, which are central to this target.

4. Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of… economic or other status.

   The article’s analysis using the Socio-demographic Index (SDI) directly relates to this target. It shows a strong negative correlation between a country’s SDI and its maternal mortality rate, stating that “countries in the low-SDI quintile had significantly higher rates” of death and DALYs compared to high-SDI countries. Reducing these health disparities is a key aspect of promoting inclusion and reducing inequality based on economic status.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Maternal Mortality Rate (Indicator 3.1.1)

  This is the most prominent indicator used throughout the article. It is explicitly mentioned and quantified as the “age-standardized maternal mortality rate,” which dropped from “12.452 per 100,000… to 4.869 per 100,000.”

• Disability-Adjusted Life Years (DALYs)

  The article uses DALYs as a comprehensive measure of the burden of maternal disorders, combining years of life lost due to premature mortality and years lived with disability. It reports that “global burden of maternal disorders, measured in DALYs, decreased from 21,798,119… to 12,314,021.” This serves as a powerful indicator of overall health improvement.

• Mortality Rate from Specific Causes

  The article provides detailed numbers and rates of death for specific causes, such as “maternal hemorrhage,” “hypertensive disorders,” and “maternal abortion and miscarriage.” These serve as specific indicators to track progress in preventing deaths from the most common maternal disorders.

• Estimated Annual Percentage Change (EAPC)

  This statistical indicator is used repeatedly in the article to measure the rate of change over time for mortality and DALYs. For example, “The EAPC for global maternal mortality was − 3.1%,” indicating a consistent annual decline.

• Socio-demographic Index (SDI)

  While not a health outcome itself, the SDI is used as a critical indicator to disaggregate data and measure inequality. The article uses it to demonstrate that progress is not uniform and that low-SDI regions face the highest burden, thereby tracking progress on SDG 10.

4. Summary of Findings

Source: bmcpublichealth.biomedcentral.com