Abstract
Background
Understanding the global trends and future projections of maternal mortality ratio (MMR) is crucial as it can provide insights into improving policies and healthcare systems aimed at enhancing the quality of obstetric care and reducing preventable deaths. Given recent reports of increasing MMR trends in some high-income countries (HICs), we aimed to analyze the global trends of MMR from 1990 to 2021 and project future trends until 2050 across 37 countries.
Methods
Age-standardized country-specific MMR for 37 countries from 1990 to 2021 were assessed through a locally weighted scatter plot smoother (LOESS) curve, with weighting based on individual country populations, utilizing the World Health Organization Mortality Database. The impact of premature mortality due to MMR was assessed by analyzing the years of life lost (YLLs). Furthermore, projections for MMR up to 2050 were derived using the Bayesian Age-Period-Cohort (BAPC) model. Decomposition analysis identified factors contributing to MMR variations such as population growth, aging and epidemiological changes.
Results
The LOESS estimate of the global MMR decreased from 25.65 deaths per 100,000 live births (95% confidence interval [CI], 22.10, 29.20) in 1990 to 10.38 (6.41, 14.36) in 2021. While most continents showed a decreasing trend, young age groups in Asia-Pacific regions and all age groups in North America exhibited no significant changes from 1990 to 2021. MMR due to direct causes declined from 25.05 deaths per 100,000 live births (95% CI, 21.71, 28.38) in 1990 to 7.66 (3.90, 11.43) in 2021 across all age groups. Conversely, MMR due to indirect causes rose from 0.33 deaths per 100,000 live births (95% CI, −0.37, 1.03) in 1990 to 4.33 (3.43, 5.23) in 2021, with a more pronounced increase in advanced age groups. YLL due to MMR decreased from 866.00 (95% CI, 692.39, 1,039.60) in 1990 to 387.05 (182.82, 591.28) in 2021. Our analysis revealed negative correlations between MMR and the Human Development Index, Socio-demographic Index, and Universal Health Coverage Service Index. BAPC models predict a continued decrease in global MMR to 4.47 (4.07, 4.89) in 2030, 2.32 (1.82, 2.89) in 2040, and 1.25 (0.86, 1.81) in 2050. However, MMR due to indirect causes is projected to consistently increase. The global decrease in MMR from 1990 to 2021 can be primarily attributed to epidemiological changes.
Conclusion
This study reveals a significant global decline in MMR since 1990, with projections indicating further decreases up to 2050, despite persistent increases in indirect causes and mortality among older age groups. These findings highlight the critical need for targeted strategies to address indirect causes and protect vulnerable populations.
Keywords: Maternal Mortality Ratio, WHO Mortality Database, Global Trend, Prediction Model
Graphical Abstract
INTRODUCTION
The maternal mortality ratio (MMR), defined as maternal deaths per 100,000 livebirths within 42 days post-partum, serves as the primary indicator for tracking maternal survival. These deaths encompass both direct obstetric and indirect non-obstetric causes related to or worsened by pregnancy.1 Maternal mortality represents an irreversible event that most women are exposed to during their lifetime. As most cases are preventable and avoidable,1 it was identified as a key concern to be addressed within the United Nations Millennium Development Goals.1 Previous studies have mentioned that considerable focus has been directed towards low- and middle-income countries (LMICs) due to their substantial contribution to the global MMR.2 These findings imply the need for global attention and healthcare system improvements.
Despite a significant 43.9% reduction in MMR from 1990 to 2015,3 achieving the United Nations' 75% reduction target by 2030 requires further examination of maternal mortality causes and epidemiology. While previous efforts focused on LMICs, recent years have seen increasing MMR trends in high-income countries (HICs) such as the United States.4 This shift underscores the need to understand how the primary causes of MMR have changed.
A study reported that from 2016 to 2020, MMR increased in more than 15 countries, primarily in Western Europe, North America, Latin America, and the Caribbean.5 This trend highlights the importance of understanding MMR in HICs, previously thought to have extremely low rates. In countries with lower MMRs, although direct causes remain significant, indirect maternal deaths tend to be slightly higher than in countries with high MMRs.6 However, studies analyzing these cause trends over time are scarce, suggesting a need to focus on HICs as well, as increasing MMR in some HICs could reveal hidden causes of stagnating global MMR reduction.
This study conducted a comparative analysis of MMRs across HICs, categorizing them by the causes of maternal death and by age groups, utilizing the World Health Organization (WHO) Mortality Database. We focused on identifying MMR cause patterns across different age groups and analyze years of life lost (YLLs) to indicate premature mortality impact. Thus, we aimed to evaluate how healthcare systems, socioeconomic factors and national policies influence these patterns. Additionally, we estimated the future MMR burden up to 2050 across 37 countries. This study will aid in improving policies and healthcare systems to enhance obstetric care quality.
METHODS
We analyzed global MMR trends by utilizing the WHO Mortality Database for 37 countries from 1990 to 2021.7,8 Bayesian age-period-cohort (BAPC) models were applied to project MMR trends up to 2050. Our study had three main interconnected objectives: 1) to identify global trends using data from 37 countries registered in the database; 2) to estimate trends up to the year 2050 using mathematical modeling; and 3) to comprehend the driving factors underlying changes in mortality rates through decomposition analysis. This study complies with the Guidelines for Accurate and Transparent Health Estimates Reporting in Supplementary Data 1.
Data sources of maternal mortality and population demographics
The main data originated from the WHO mortality database, which compiles annual mortality statistics through their civil registration systems. These statistics encompass mortality data categorized by age and cause of death. From the database, we retrieved crude MMR figures along with corresponding population estimates across various countries, and age groups between 1990 and 2021.7,9 The inclusion criteria stipulated that a minimum of complete data spanning at least 10 years between 1990 and 2021 was required. The study focused on HICs as classified by the World Bank, resulting in the inclusion of 37 countries meeting these criteria.10 The data reported to the WHO by each country were presented without adjustments for any incompleteness, and the number of deaths is depicted as absolute values, including zero.7
To ensure data accuracy, cases outside the defined age range of 15–49 years, as well as those with unknown sex or identified as male, were excluded from the analysis. The causes of maternal mortality can broadly be classified into direct maternal deaths and indirect maternal deaths. Direct maternal deaths occur due to complications in the pregnant state, interventions, omissions, incorrect treatments, or a series of events stemming from any of these causes.11 Indirect maternal deaths arise from pre-existing or pregnancy-developed diseases not directly related to obstetric causes but exacerbated by the physiological effects of pregnancy.12
The causes of maternal mortality were classified according to the International Statistical Classification of Diseases and Related Health Problems (ICD) code. We identified MMR using ICD-9 codes (630–648 or 650–676) and ICD-10 codes (A34, F53, O00–O95, or O98–99) (Supplementary Table 1) for all causes of MMR, ICD-9 codes (630–646 or 650–676) and ICD-10 codes (A34, F53, O00–O23, O244, or O26–O95) for direct causes and ICD-9 codes (647–648) and ICD-10 codes (O23–O243, O245–O25, or O98–O99) for indirect causes. The population data for each country were sourced from the United Nations dataset. One author (SK) conducted data collection, utilizing Python software (version 3.11.4; Python Software Foundation, Wilmington, DE, USA) to address any duplicate entries and missing values.
Global trends analysis via locally weighted scatter plot smoother (LOESS) curve
Age-standardized MMR was computed to accommodate variations in population distributions across countries and timeframes. Rates were analyzed for specific age groups, ranging from 15 to 49 years in 5-year intervals, utilizing the age distribution data specific to each country.10 This process underwent independent execution and cross-verification by two researchers (SL and SK), ensuring precise mortality calculations (Supplementary Data 2). The LOESS methodology was selected to account for the incomplete and irregular characteristics of the dataset. This model facilitates trend interpretation without overfitting to short-term fluctuations or exhibiting excessive sensitivity to outliers, thereby ensuring a reliable representation of mortality trends even in the presence of missing data.9
For trend analysis, we utilized a LOESS curve, weighted by individual country populations, to generate smoothed curves depicting global trends in MMR over time across 37 countries (Supplementary Table 2).13 This study investigates various trends in MMRs across countries based on economic conditions, using the World Bank's gross national income (GNI) per capita criteria. Countries were classified as HICs and continents, with an economic threshold set at $13,846 (Supplementary Table 3).14
The LOESS curve, a smoothing technique, connects data points while considering local variability, enabling the identification of the overall trend in the dataset. The smoothing parameter was determined using the default optimization procedure in the software.10 In our analysis, we calculated the β-coefficient and odds ratio using estimates derived from the LOESS curve for each year to estimate the global trends. Linear regression and logistic regression models were employed for each analysis. Mortality rates were expressed per 100,000 live births with 95% confidence intervals (CI), and statistical significance was set at two-sided P < 0.05. Further details can be found in the Supplementary Data 2. LOESS curve fitting, analysis, and visualization was conducted using SAS (version 9.4; SAS Inc., Cary, NC, USA) and Python software (version 3.11.4; Python Software Foundation).
Associated factors
Four indices were employed to examine the correlation between the country-specific average MMR and various socio-economic indicators. For visualization and correlation analysis, encompassing scatter plot generation and linear regression, we utilized Human Development Index (HDI), Socio-demographic Index (SDI), Universal Health Coverage (UHC) Service Index, and Gini Coefficient.14
The HDI, developed by the United Nations, evaluates human development based on factors such as health, education, and living standards.7 This categorization underscores the potential for countries with comparable GNI levels to exhibit diverse levels of human development. The SDI, derived from the Global Burden of Diseases Study (GBD), gauges developmental status by considering components like income, education, and birth rates.14 The UHC service index, sourced from the WHO and World Bank, gauges the extent to which all individuals receive necessary health services of high quality without encountering financial difficulties.14 The Gini Coefficient, obtained from the World Bank, evaluates income inequality within an economy.15
HDI and SDI are standardized within a range of 0 to 1, where values nearing 1 signify greater development or equality.16 The UHC service index values were standardized on a scale of 0 to 100, reflecting improved health outcomes for populations across varied contexts.17 In contrast, the Gini Coefficient ranges from 0 to 100, with higher values indicating greater income inequality. The results from correlation analysis are presented as β coefficients and P values.
A scatter plot was created using the average MMR for each country along with the latest indices reported by each organization. Subsequently, a linear regression analysis was conducted to ascertain the association between these variables (Supplementary Data 2). The results were presented as β-coefficients and corresponding P values.
BAPC statistical modeling
We employed BAPC models to project MMR from 2022 to 2050 based on death and population data from 37 countries.18 This model comprehensively examines changes in mortality rates over time by incorporating the linear combinations of age, period, and cohort factors.18 Furthermore, it allows for the exploration of various combinations of constant (random walk of first order) or linear time trends (random walk of second order) when modeling the effects of age, period, and cohort.19 The predictive accuracy from 2011 to 2021 was validated using data from 1990 to 2010, and optimal parameters for each effect were determined through this verification process, relying on root mean square errors19 Additionally, to address heterogeneity among subgroups, we employed the BAPC model, considering factors such as age, income, and continent. The resulting predictions from the model were depicted as age-standardized median estimates, accompanied by 95% CIs. The details regarding BAPC are elaborated in the Supplementary Data 2. The statistical analysis utilizing the BAPC model was carried out using the 'bamp' package in R software (version 4.1.2; R Foundation, Vienna, Austria).
Decomposition analysis
Decomposition analysis was conducted to examine variations in age-specific MMR attributed to three factors: population growth, aging, and epidemiological shifts between 1990 and 2021. Epidemiological change is defined as the adjusted changes in MMR that account for age and population size.
This method integrated data on population size, age-specific mortality rates, and the distribution of the population across specific age brackets, comparing data from the reference years (e.g., 1990 [scenario one], 2021 [scenario two], and 2050 [scenario three] in this study).19 We estimated the impact of population growth by subtracting the actual deaths in 1990 from scenario one. Additionally, we determined the effect of population aging by comparing the differences between scenario two and scenario one. Finally, we calculated the change attributable to the age-specific mortality ratio by subtracting scenario two from the actual deaths in 2021. The same calculations were performed for scenario one and scenario three.19
Moreover, this method addresses limitations found in other decomposition techniques that could be influenced by the selection of decomposition order and the reference year group, potentially resulting in inconsistent outcomes from identical data sets.19,20 Following the categorization of our data by cause-specific maternal mortality, we computed the absolute contribution to the trend of MMR using the decomposition method. This absolute contribution represented the number of MMR attributed to the three components, with positive and negative contributions indicating increases and decreases in total deaths, respectively. To access further detailed information, please direct yourself to the Supplementary Data 2. The decomposition analyses were performed using the statistical software R.
Ethics statement
The study protocol was approved by the Institutional Review Board of Kyung Hee University (KHSIRB-23-085). The requirement for written consent was waived by the board owing to the population-level dataset.
RESULTS
Age-standardized MMR from 1990 to 2021 was available for 37 countries from the WHO Mortality Database (Table 1 and Supplementary Table 4). The LOESS smoothed age-standardized rate for MMR decreased by 59.53% from 25.65 deaths per 100,000 live births (95% CI, 22.10, 29.20) in 1990 to 10.38 deaths per 100,000 live births (95% CI, 6.41, 14.36) in 2021 (Table 1). Similar patterns were observed among every age subgroup (Supplementary Tables 5, 6, 7, 8, 9, 10, 11 and Supplementary Figs. 1, 2, 3, 4, 5, 6, 7). When classified into four continents and age groups, most groups exhibited a decreasing trend. However, the age group between 15–19 years in Asia-Pacific countries showed an increasing trend from 1990 (5.74 [95% CI, −9.84, 21.32] deaths per 100,000 live births) to 2021 (18.97 [0.65, 37.29]). North American countries did not exhibit significant changes compared to other continents (Supplementary Tables 5, 6, 7, 8, 9, 10, 11 and Supplementary Figs. 8, 9, 10, 11, 12, 13, 14).
Table 1. LOESS smoothed mortality and YLLs for maternal mortality ratio attributed to all causes, direct causes, and indirect causes (per 100,000 live births) across variables in 37 countries for 1990 and 2021.
| Variables | Mortality | YLLs | ||||||
|---|---|---|---|---|---|---|---|---|
| 1990 | 2021 | AAPC in age-standardized mortality rate per 100,000 live births (95% CI) | 1990 | 2021 | AAPC in age-standardized YLLs rate per 100,000 live births (95% CI) | |||
| All causes | ||||||||
| Overall | 25.65 (22.10, 29.20) | 10.38 (6.41, 14.36) | −2.91 (−2.99, −2.83) | 866.00 (692.39, 1,039.60) | 387.05 (182.82, 591.28) | −2.46 (−3.30, −1.62) | ||
| Geographical areas | ||||||||
| Asia-Pacific | 14.57 (11.99, 17.16) | 6.10 (3.06, 9.14) | −2.79 (−2.81, −2.77) | 744.90 (583.00, 906.80) | 157.03 (−30.98, 345.04) | −4.90 (−5.51, −4.28) | ||
| Europe | 20.81 (17.94, 23.69) | 6.12 (2.81, 9.43) | −4.18 (−4.73, −3.64) | 663.27 (566.88, 759.67) | 81.47 (−30.94, 193.88) | −6.48 (−7.00, −5.95) | ||
| Latin America and the Caribbean | 68.71 (53.76, 83.67) | - | −6.49 (−11.27, −1.45) | 549.46 (435.77, 663.16) | - | −8.65 (−14.10, −2.86) | ||
| North America | 10.87 (7.95, 13.78) | - | −3.05 (−7.43, 1.54) | 3,458.70 (1,776.21, 5,141.18) | - | −6.44 (−13.82, 1.57) | ||
| Age group, yr | ||||||||
| 15–19 | 15.91 (11.35, 20.47) | 11.65 (6.54, 16.76) | −0.95 (−1.20, −0.69) | 307.57 (234.58, 380.57) | 69.03 (−16.84, 154.90) | −4.38 (−4.99, −3.76) | ||
| 20–24 | 14.78 (12.14, 17.42) | 6.81 (3.86, 9.76) | −2.48 (−2.56, −2.41) | 843.70 (671.96, 1,015.44) | 233.10 (31.07, 435.13) | −3.80 (−4.61, −2.97) | ||
| 25–29 | 20.83 (15.69, 25.98) | 7.60 (1.35, 13.85) | −3.26 (−3.67, −2.85) | 1,029.89 (828.53, 1,231.25) | 431.86 (196.54, 667.18) | −2.75 (−3.60, −1.89) | ||
| 30–34 | 39.90 (33.14, 46.67) | 10.25 (2.58, 17.92) | −4.29 (−4.43, −4.15) | 1,000.15 (802.41, 1,197.89) | 503.75 (271.14, 736.36) | −2.11 (−2.92, −1.30) | ||
| 35–39 | 72.11 (61.16, 83.06) | 11.22 (−1.25, 23.70) | −5.67 (−5.88, −5.46) | 605.02 (467.16, 742.88) | 434.33 (275.86, 592.80) | −1.03 (−1.74, −0.31) | ||
| 40–44 | 155.53 (125.46, 185.59) | 25.45 (−11.09, 61.99) | −4.90 (−5.41, −4.39) | 200.93 (137.45, 264.42) | 198.78 (125.80, 271.76) | 0.22 (−0.56, 1.01) | ||
| 45–49 | 229.92 (110.59, 349.25) | 166.33 (30.39, 302.27) | −1.19 (−1.58, −0.80) | 8.21 (−17.72, 34.14) | 63.91 (34.85, 92.97) | 7.12 (6.83, 7.41) | ||
| Direct causes | ||||||||
| Global | 25.05 (21.71, 28.38) | 7.66 (3.90, 11.43) | −3.77 (−3.83, −3.71) | 838.15 (693.13, 983.17) | 274.43 (102.43, 446.42) | −3.63 (−4.49, −2.77) | ||
| Geographical areas | ||||||||
| Asia-Pacific | 13.96 (11.64, 16.28) | 3.72 (0.97, 6.47) | −4.08 (−4.23, −3.92) | 766.58 (600.34, 932.82) | 118.31 (−79.56, 316.18) | −5.79 (−6.52, −5.05) | ||
| Europe | 20.40 (17.56, 23.24) | 4.21 (0.91, 7.52) | −5.27 (−5.73, −4.81) | 638.32 (545.97, 730.68) | 65.31 (−43.62, 174.24) | −7.21 (−7.73, −6.68) | ||
| Latin America and the Caribbean | 67.60 (53.17, 82.02) | - | −6.96 (−11.58, −2.09) | 533.24 (430.01, 636.46) | - | −9.48 (−14.67, −3.96) | ||
| North America | 10.89 (7.77, 14.01) | - | −4.11 (−8.20, 0.16) | 3,507.46 (2,126.97, 4,887.94) | - | −7.67 (−14.69, −0.06) | ||
| Age group, yr | ||||||||
| 15–19 | 15.12 (10.69, 19.55) | 8.98 (3.98, 13.99) | −1.58 (−1.80, −1.35) | 300.05 (233.20, 366.90) | 45.31 (−33.98, 124.59) | −5.73 (−6.34, −5.12) | ||
| 20–24 | 14.35 (11.97, 16.73) | 4.60 (1.91, 7.29) | −3.63 (−3.70, −3.57) | 824.08 (675.54, 972.62) | 157.39 (−18.78, 333.56) | −5.20 (−6.04, −4.34) | ||
| 25–29 | 19.12 (13.80, 24.43) | 6.12 (−0.24, 12.48) | −3.91 (−4.43, −3.40) | 1,000.64 (828.13, 1,173.16) | 304.86 (100.25, 509.46) | −3.93 (−4.81, −3.03) | ||
| 30–34 | 39.83 (33.11, 46.55) | 8.42 (0.70, 16.14) | −3.21 (−4.02, −2.40) | 966.14 (802.50, 1,129.77) | 362.24 (168.17, 556.32) | −4.93 (−5.13, −4.73) | ||
| 35–39 | 70.93 (60.21, 81.65) | 6.91 (−5.39, 19.22) | −6.76 (−7.16, −6.37) | 593.93 (480.48, 707.37) | 312.20 (183.88, 440.52) | −2.14 (−2.84, −1.43) | ||
| 40–44 | 147.18 (120.70, 173.66) | 18.15 (−13.25, 49.56) | −5.73 (−6.10, −5.36) | 199.19 (151.53, 246.86) | 140.36 (86.44, 194.27) | −1.08 (−1.90, −0.26) | ||
| 45–49 | 228.55 (110.82, 346.27) | 148.21 (13.02, 283.39) | −1.60 (−2.06, −1.14) | 10.80 (−4.05, 25.65) | 38.20 (21.42, 54.98) | 4.68 (4.40, 4.96) | ||
| Indirect causes | ||||||||
| Global | 0.33 (−0.37, 1.03) | 4.33 (3.43, 5.23) | 6.51 (5.25, 7.78) | 8.80 (−32.71, 50.30) | 193.15 (139.33, 246.96) | 8.32 (7.18, 9.47) | ||
| Geographical areas | ||||||||
| Asia-Pacific | 0.53 (−0.66, 1.71) | 9.84 (7.43, 12.25) | 5.87 (5.44, 6.30) | 30.64 (9.83, 51.45) | 62.79 (35.44, 90.15) | 2.28 (2.06, 2.50) | ||
| Europe | 0.53 (−0.58, 1.64) | 9.84 (7.43, 12.25) | 8.14 (6.53, 9.78) | 19.92 (5.46, 34.39) | 22.41 (4.35, 40.47) | 2.09 (1.09, 3.10) | ||
| Latin America and the Caribbean | 1.22 (−2.29, 4.73) | - | 0.98 (−3.80, 6.00) | 19.43 (1.71, 37.15) | - | −1.43 (−6.97, 4.45) | ||
| North America | −0.18 (−1.07, 0.72) | - | - | −78.71 (−512.46, 355.03) | - | - | ||
| Age group, yr | ||||||||
| 15–19 | 0.71 (−0.71, 2.12) | 4.30 (2.47, 6.13) | 5.45 (5.14, 5.76) | 2.41 (−11.10, 15.93) | 45.60 (28.33, 62.86) | 7.44 (6.05, 8.85) | ||
| 20–24 | 0.31 (−0.58, 1.19) | 3.64 (2.50, 4.77) | 6.48 (5.32, 7.67) | 4.63 (−36.63, 45.89) | 145.77 (93.06, 198.49) | 8.48 (6.89, 10.10) | ||
| 25–29 | 0.62 (−0.34, 1.58) | 2.38 (1.21, 3.55) | 5.10 (4.02, 6.20) | 17.82 (−30.98, 66.63) | 223.46 (160.17, 286.74) | 7.32 (6.53, 8.13) | ||
| 30–34 | 0.58 (−1.57, 2.73) | 3.49 (0.66, 6.31) | 8.25 (7.22, 9.29) | 11.87 (−37.27, 61.00) | 235.80 (172.09, 299.51) | 5.42 (3.78, 7.09) | ||
| 35–39 | −0.15 (−2.46, 2.15) | 7.42 (4.64, 10.21) | - | −3.83 (−42.17, 34.51) | 193.62 (143.91, 243.33) | - | ||
| 40–44 | 4.47 (−1.88, 10.81) | 7.58 (−0.11, 15.28) | 3.65 (2.54, 4.77) | −6.64 (−30.66, 17.38) | 98.56 (68.28, 128.84) | - | ||
| 45–49 | −0.49 (−20.63, 19.65) | 33.92 (7.81, 60.04) | - | 0.72 (−26.56, 28.00) | 2.89 (−32.76, 38.54) | 15.41 (11.57, 19.37) | ||
Values are presented as LOESS smoothed rate (95% CI).
LOESS = locally weighted scatter plot smoother, YLLs = years of life lost, AAPC = average annual percent change, CI = confidence interval.
Global trends in MMR exhibit significant differences when classified by causes (Table 1 and Fig. 1). MMR due to direct causes decreased from 25.05 deaths per 100,000 live births (95% CI, 21.71, 28.38) in 1990 to 7.66 deaths per 100,000 live births (95% CI, 3.90, 11.43) in 2021. This decreasing trend was observed across all age groups except for the 45–49 years age group in North America, Latin America, and the Caribbean (Supplementary Tables 12, 13, 14, 15, 16, 17, 18, 19 and Supplementary Figs. 15, 16, 17, 18, 19, 20, 21, 22). However, MMR due to indirect causes increased from 0.33 deaths per 100,000 live births (95% CI, −0.37, 1.03) in 1990 to 4.33 deaths per 100,000 live births (95% CI, 3.43, 5.23) in 2021. This increasing trend was more pronounced in the oldest age groups and Europe (Supplementary Tables 20, 21, 22, 23, 24, 25, 26, 27 and Supplementary Figs. 23, 24, 25, 26, 27, 28, 29, 30).
Fig. 1. Age-standardized maternal mortality ratio attributed to all causes, direct causes, and indirect causes for the global population among 37 countries for the years 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red.
LOESS = locally weighted scatter plot smoother.
Considerable variations exist among different geographical regions (Fig. 2). Fig. 2 shows age-standardized MMR across the four continents among 37 countries from 1990 to 2021. The LOESS smoothed curves of MMR in every continent aside from North America exhibited a downward trend (Asia-pacific, 14.57 [95% CI, 11.99, 17.16] deaths per 100,000 live births in 1990 and 6.10 [3.06, 9.14] in 2021; Europe, 20.81 [17.94, 23.69] in 1990 and 6.12 [2.81, 9.43] in 2021; Latin America and the Caribbean, 68.71 [53.76, 83.67] in 1990 and 37.14 [21.33, 52.95] in 2021).
Fig. 2. Age-standardized all causes of MMR across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
MMR = maternal mortality ratio, LOESS = locally weighted scatter plot smoother.
The trends of MMR by age group are depicted in Fig. 3. The age group between 20−24 years consistently exhibited the lowest LOESS smoothed curve for MMR across all years, particularly MMR due to direct causes, indicating a J-shaped curve in age distribution. The age group between 15−19 years showed a slightly elevated risk of MMR compared to the age group between 20−24 years (15−19 years, 15.91 [95% CI, 11.35, 20.47] deaths per 100,000 live births in 1990 and 11.65 [6.54, 16.76] in 2021; 20−24 years, 14.78 [12.14, 17.42] in 1990 and 6.81 [3.86, 9.76] in 2021; Fig. 3). The older population consistently exhibited higher MMR every year, with the age group between 44−49 years showing particularly increased risks (44−49 years, 229.92 [95% CI, 110.59, 349.25] deaths per 100,000 live births in 1990 and 166.33 [30.39, 302.27] in 2021; Table 1). This trend is more significant in MMR due to indirect causes, with the ratio in the age group between 44−49 years increased from −0.49 deaths per 100,000 live births (95% CI, −20.63, 19.65) in 1990 to 33.92 deaths per 100,000 live births (95% CI, 7.81, 60.04) in 2021 (Table 1). The detailed analysis of age-specific MMR by causes is depicted in Supplementary Figs. 31, 32, 33, 34.
Fig. 3. LOESS smoothed MMR attributed to all causes, direct causes, and indirect causes by sex and age group among 37 countries, 1990–2021.
MMR = maternal mortality ratio, LOESS = locally weighted scatter plot smoother.
As global MMR decreased significantly from 1990 to 2021, YLLs present similar patterns with the MMR trend, decreasing from 866.00 (95% CI, 692.39, 1,039.60) to 387.05 (95% CI, 182.82, 591.28; Table 1). The detailed analysis of YLLs for all causes, direct causes, and indirect causes of each age group is depicted in Supplementary Tables 28, 29, 30, 31, 32, 33, 34, 35, Supplementary Tables 36, 37, 38, 39, 40, 41, 42, 43, and Supplementary Tables 44, 45, 46, 47, 48, 49, 50, 51, respectively.
The age-standardized MMR correlates negatively with the HDI (β, −337.83 and P < 0.001), SDI (β, −261.88 and P < 0.001), and UHC service index (β, −3.00 and P < 0.001) and positively with the Gini coefficient (β, 1.34 and P < 0.001; Fig. 4). The correlation between age-standardized MMR due to direct causes and indirect causes exhibited similar patterns to MMR due to all causes (Supplementary Figs. 35 and 36).
Fig. 4. Correlation between age-standardized all causes MMR and human development index, socio-demographic index, UHC service index, and Gini coefficient.
MMR = maternal mortality ratio, UHC = Universal Health Coverage.
Based on the BAPC models, age-standardized MMR was predicted to significantly decrease from 10.38 deaths per 100,000 live births (95% CI, 6.41, 14.36) in 2021, to 4.47 (95% CI, 4.07, 4.89) in 2030, 2.32 (95% CI, 1.82, 2.89) in 2040 and 1.25 (95% CI, 0.86, 1.81) in 2050 (Fig. 5 and Supplementary Table 52). Detailed information is presented in Supplementary Tables 53 and 54. However, MMR due to indirect causes was predicted to consistently increase. Differences in MMR between the reference year and each subsequent year were decomposed into three components, including population aging, epidemiological change, and population growth (Fig. 6). From 1990 to 2021, the decrease in MMR globally can be attributed to a prominent factor (epidemiological change). Similar patterns are observed until 2050.
Fig. 5. Projections in age-standardized MMR attributed to all causes, direct causes, and indirect causes from 2022 to 2050 by Bayesian age-period-cohort models. (A) Represents all causes of MMR, (B) denotes direct causes of MMR, and (C) signifies indirect causes of MMR.
MMR = maternal mortality ratio.
Fig. 6. Changes in the number of maternal deaths attributed to all causes, direct causes, and indirect causes associated with aging, epidemiological change, and population from 1990 to 2021 and 1990 to 2050.
DISCUSSION
The present study found an overall decline in the estimated global age-standardized MMR across 37 countries, decreasing by 59.53% from 25.65 to 10.38 deaths per 100,000 live births between 1990 and 2021. Geographically, although most age groups and continents exhibited a decreasing trend, with notable decreases observed in Europe, the 15–19 years age group in Asia-Pacific countries and all age groups in North America did not show significant changes. When analyzing trends by cause, MMR due to direct causes decreased across all age groups. However, MMR attributable to indirect causes showed an increasing trend across all age groups, except for the 45–49 years age group in North America, Latin America, and the Caribbean. Among age groups, the older age group consistently exhibited higher MMR every year, with the 45–49 years age group showing particularly increased risks for both direct and indirect causes. YLLs present similar patterns to the MMR trend, decreasing from 866.00 in 1990 to 387.05 in 2021. Our analysis further revealed negative correlations between MMR and various indices, including the HDI, SDI, and UHC. From 1990 to 2021, the decrease in MMR globally can be attributed to the prominent factor (epidemiological change), particularly within LMICs. Similar patterns are projected until 2050. Future trends based on BAPC models suggest a continued and significant decrease in MMR, with forecasts indicating a decline by 2050. However, the consistent increase of MMR due to indirect causes is concerning.
Global initiatives like Sustainable Development Goals mainly target LMICs, however the recent increase in HICs is concerning. This trend is particularly noticeable in indirect causes of maternal mortality. Our findings align with previous studies highlighting substantial increases in Western Europe and North America.5 Several factors contribute to this trend. Direct causes of maternal mortality have declined in HICs since 1990. However, indirect causes have increased. These could be related to pre-existing medical conditions that are exacerbated by pregnancy.11,21 The rise in indirect causes can be attributed to pre-existing medical conditions that worsen during pregnancy, necessitating detection. These conditions contribute to pregnancy complications like gestational diabetes, venous thromboembolism, and pre-eclampsia.22 Multiple socioeconomic factors influence these health outcomes, including economic stability, education access and quality, healthcare access and quality, neighborhood characteristics, and social context. These factors, along with individual risk factors such as underlying diseases, obesity, dietary patterns, environmental factors, and age, comprehensively influence the current increasing trend of indirect maternal deaths, contributing significantly to health inequities.23 While these conditions were traditionally associated with HICs, recent global analyses show that the transition from traditional to industrialized diets has been abrupt across both HICs and LMICs.24
Infectious diseases also play a role. Respiratory infections can worsen underlying conditions like asthma or heart disease.25 Historical epidemics significantly impacted maternal mortality. The 1918 influenza and 1957 Asian flu epidemics resulted in 30% to 50% maternal mortality rates. Similarly, during the SARS epidemic of 2003, which primarily affected Asia, a fatality rate of 25% among pregnant women was reported.25 Recent research suggests influenza still causes substantial deaths in HICs.26 It is believed that the most recent COVID-19 pandemic could also significantly impact maternal mortality rates.
High MMR reported in the younger age groups under 20 years and older age groups over 40 years aligns with previous studies. This trend is thought to arise due to economic challenges or lower educational attainment among young women under 20 years, while older women are at a higher risk of obstetric complications such as gestational hypertension and pre-eclampsia.27 In HICs, societal changes have influenced maternal age trends. Increased industrialization, higher female education rates, and greater female employment have led to more women becoming mothers after age 35.28 Advanced maternal age is associated with increased cardiac, respiratory, and cerebrovascular morbidity. These risks are partly due to age-related physiological changes, which can be aggravated during pregnancy.29 This shift necessitates heightened attention to advanced maternal age risks.
Additionally, there is increasing concern about disparities among minority populations. Previous studies reported that in the United States, the MMR was twice as high in females of Black ethnic origin compared to thos of White.30 Similarly, the United Kingdom exhibited increased MMR risk among minority ethnic groups.31 Structural and cultural factors may have influenced education, health knowledge, income levels, and employment rates among females, leading to disparities among minorities. Inequitable access to quality healthcare and varying prevalence of health risk factors across ethnic groups contribute to MMR disparities.32
Our study has several limitations. Firstly, due to the constraints in the classification of diagnoses, certain codes were excluded that might have contributed to MMR, such as I40 (acute myocarditis), Y60 (unintentional cut, puncture, perforation or hemorrhage during surgical and medical care), and Y87 (sequelae of intentional self-harm, assault, and events of undetermined intent). The previous study33 included I40, Y60, and Y87 as they could potentially be linked to maternal death. However, due to the absence of specific subcodes exclusively referring to pregnancy, we were unable to include those codes.
Another limitation of our study is the potential for misclassification during the reporting and diagnosis of causes of death. Even in HICs with comparatively well-established healthcare systems, misclassification, particularly in indirect causes, is a concern. Previous studies have reported misclassification rates of 81% in Austria34 and 74% in the United Kingdom,6 indicating a need for caution regarding bias. Additionally, the classification of a condition as a direct or indirect cause can vary.11 For example, anemia is classified as an indirect cause in countries where malaria is prevalent, but as a direct cause in others. Similarly, psychiatric conditions like depression may be classified as indirect if previously diagnosed, but as direct in other cases.11 This ambiguity has been highlighted in previous research, suggesting caution in overemphasizing either direct or indirect causes. Moreover, the ICD-10 coding system does not allow for dual coding of causes,2 meaning if two factors contribute to a death, only one is reported, which is a significant limitation.
Additionally, the limitation of this study is the inherent incompleteness of the mortality data, even within HICs that typically possess robust healthcare systems.35 Despite intentionally selecting HICs for analysis, certain countries presented gaps in reported mortality figures, which could potentially affect the accuracy of our findings. Specifically, missing data may lead to underestimations or misinterpretations of maternal mortality rates. To address these challenges, we employed the LOESS methodology.35 This approach enables us to interpret trends without overfitting to short-term fluctuations and reduces sensitivity to outliers. By utilizing LOESS, we aimed to provide a more stable representation of mortality trends despite the limitations posed by incomplete data.
Lastly, even HICs face challenges in accurately reporting maternal mortality causes due to limitations in national vital statistics and potential underreporting. WHO advocates for robust surveillance systems and routine updates of mortality data in all countries.36 However, HICs often deprioritize timely, high-quality perinatal data collection, perceiving MMR as a less pressing issue.36 Specific causes also face underreporting issues. In countries where abortion is a social taboo, deaths resulting from abortion might be incorrectly classified. Additionally, even in regions where induced abortion is legal, prevailing cultural and religious beliefs may cause individuals to conceal abortion attempts, leading to such deaths not being accurately reported.2 Conversely, overreporting is also a concern. Obstructed labor may be overreported due to unclear diagnostic criteria in clinical settings.2 This overreporting can mislead into believing that operative delivery can prevent all maternal deaths, necessitating cautious interpretation.
This study holds several key strengths in comparison to previous research that heavily relies on the GBD, Injuries, and Risk Factors data.3 A notable aspect is our exclusive reliance on raw data from the WHO Mortality Database for analysis, setting our investigation apart from prior studies. GBD studies, aiming to incorporate as many countries as possible, aggregate data from multiple institutions and case reports through meta-regression, which may introduce possible bias. Apart from the GBD study, various endeavors to estimate global MMR through meta-regression have shown discrepancies among studies.3,37 Considering the potential unreliability and bias inherent in existing data, there is a possibility of bias or errors in the resulting estimates. As mentioned in previous studies, two different models were utilized: an aggregated-level regression model and an individual-level structural simulation model, for countries that did not report data. This resulted in significant disparities between studies.
However, our study relied on the WHO Mortality Database, which directly reports raw mortality data from WHO member countries, thus reducing the likelihood of bias and enabling closer reporting and prediction. Additionally, in previous study on age-specific analysis of MMR,38 the average number of adjacent years was used for unreported years, thereby making it less accurate compared to our study. Furthermore, apart from one study,37 most studies analyzing the trend of global MMR examined data only until 2015, failing to reflect recent trends. Finally, our study highlights a notable increase in maternal mortality due to indirect causes in HICs. This underscores the global significance of indirect maternal deaths. As HICs are undergoing advanced maternal aging trend recently, this accounts for the higher increase in MMR due to indirect causes in HICs. This underscores the importance of preparing for the demographic shift, including efforts to reduce MMR.
Cost-effective, policy-oriented health initiatives greatly enhance overall population health. Free and comprehensive prenatal programs benefit expectant individuals by enabling the early identification and multidisciplinary management of high-risk pregnancies.39 Simple screenings during prenatal care for conditions like HIV, obesity, diabetes, and hypertension can identify pre-existing diseases in women, potentially leading to a significant reduction in MMR.2 Furthermore, broader structural issues within society need to be addressed. Considering MMR as an intersectoral issue, it's not only the individual underlying health conditions of women that matter but also the resolution of national issues like sanitation, transportation, education levels, and conflict. Enhancing women's rights provides opportunities for women to take an interest in their health, contributing to the reduction of MMR. Addressing this issue is important as females from ethnic minorities, those with lower education and income levels, and immigrants are more vulnerable. Therefore, it is necessary to provide social support, such as aiding pre- and perinatal care, to help these high-risk populations. Additionally, in HICs, obesity, a major contributor to MMR, should be managed through national subsidized programs that support pre-pregnancy weight loss and monitor to prevent excessive weight gain during pregnancy.
In conclusion, there has been a notable and consistent decline in global MMR since 1990. However, the persistent increase in MMR due to indirect causes has raised concerns, particularly in older age groups. Utilizing models that accounted for age, period, and cohort effects on MMR trends, projections indicate a global decrease in MMR up to 2050, despite the continued rise in indirect causes and mortality among older age groups. These findings underscore the imperative for implementing consistent and effective strategies to reduce preventable MMR, particularly for vulnerable populations such as very young and older age groups, with attention to addressing indirect causes of maternal mortality.
ACKNOWLEDGMENTS
The authors acknowledge the World Health Organization for permission to access and use the data analyzed in this study. The information provided should not be interpreted as representing the official statement of the World Health Organization.
Footnotes
Funding: This research was supported by the MSIT (Ministry of Science and ICT), Korea, under the ITRC (Information Technology Research Center) support program (IITP-2024-RS-2024-00438239) supervised by the IITP (Institute for Information & Communications Technology Planning & Evaluation) and Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (RS-2024-00460379). The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Disclosure: The authors have no potential conflicts of interest to disclose.
Data Availability Statement: The WHO Mortality database is a global collaborative dataset for mortality rates reported by WHO member countries. Study protocol and statistical code are available from Dong Keon Yon (Email: yonkkang@gmail.com). Data set: available from the WHO through a data use agreement.
- Conceptualization: Lee S, Kim S, Woo S, Yon DK.
- Data curation: Lee S, Kim S, Woo S, Yon DK.
- Formal analysis: Lee S, Kim S, Woo S, Yon DK.
- Funding acquisition: Yon DK.
- Investigation: Lee S, Kim S, Woo S, Yon DK.
- Methodology: Lee S, Kim S, Woo S, Yon DK.
- Project administration: Lee S, Kim S, Woo S, Yon DK.
- Resources: Lee S, Kim S, Woo S, Yon DK.
- Software: Lee S, Kim S, Woo S, Yon DK.
- Supervision: Yon DK.
- Validation: Lee S, Kim S, Woo S, Yon DK.
- Visualization: Lee S, Kim S, Woo S, Yon DK.
- Writing - original draft: Lee S, Kim S, Woo S, Yon DK.
- Writing - review & editing: Lee S, Kim S, Lee H1, Park J, Son Y, Sánchez GFL, Pizzol D, Lee J, Lee YJ, Lee H2, Kim HJ, Smith L, Woo S, Yon DK.
Lee H1, Hyeri Lee; Lee H2, Hayeon Lee.
SUPPLEMENTARY MATERIALS
Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER)
Age-standardized mortality rate calculation, socio-economic indicators, and advanced statistical methods
Maternal mortality ratio by various causes ICD-9 and ICD-10 code list
List of 37 countries along with their corresponding 3 letter codes
Classification of countries into continent groups
LOESS smoothed all causes for maternal mortality ratio (per 100,000 live births) in 37 countries, 1990–2021
LOESS smoothed all causes for maternal mortality ratio (per 100,000 live births) among individuals aged 15–19 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal mortality ratio (per 100,000 live births) among individuals aged 20–24 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal mortality ratio (per 100,000 live births) among individuals aged 25–29 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal mortality ratio (per 100,000 live births) among individuals aged 30–34 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal mortality ratio (per 100,000 live births) among individuals aged 35–39 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal mortality ratio (per 100,000 live births) among individuals aged 40–44 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal mortality ratio (per 100,000 live births) among individuals aged 45–49 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal mortality ratio (per 100,000 live births) in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal mortality ratio (per 100,000 live births) among individuals aged 15–19 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal mortality ratio (per 100,000 live births) among individuals aged 20–24 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal mortality ratio (per 100,000 live births) among individuals aged 25–29 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal mortality ratio (per 100,000 live births) among individuals aged 30–34 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal mortality ratio (per 100,000 live births) among individuals aged 35–39 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal mortality ratio (per 100,000 live births) among individuals aged 40–44 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal mortality ratio (per 100,000 live births) among individuals aged 45–49 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal mortality ratio (per 100,000 live births) in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal mortality ratio (per 100,000 live births) among individuals aged 15–19 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal mortality ratio (per 100,000 live births) among individuals aged 20–24 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal mortality ratio (per 100,000 live births) among individuals aged 25–29 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal mortality ratio (per 100,000 live births) among individuals aged 30–34 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal mortality ratio (per 100,000 live births) among individuals aged 35–39 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal mortality ratio (per 100,000 live births) among individuals aged 40–44 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal mortality ratio (per 100,000 live births) among individuals aged 45–49 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal YLLs ratio (per 100,000 live births) in 37 countries, 1990–2021
LOESS smoothed all causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 15–19 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 20–24 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 25–29 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 30–34 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 35–39 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 40–44 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 45–49 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal YLLs ratio (per 100,000 live births) in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 15–19 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 20–24 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 25–29 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 30–34 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 35–39 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 40–44 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 45–49 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal YLLs ratio (per 100,000 live births) in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 15–19 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 20–24 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 25–29 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 30–34 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 35–39 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 40–44 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 45–49 years in 37 countries, 1990–2021
The age-standardized maternal mortality ratio (95% credible intervals) at the national level is estimated for 2030, 2040, and 2050 using Bayesian age-period-cohort models, categorized by continent
Hyperparameter estimates of age, period, and cohort effects calculated by Bayesian age-period-cohort models for trends in various causes of mortality ratio by continent using data from 1990 to 2021 are provided
Projection performance results of the Bayesian age-period-cohort model, evaluated using the root mean square error methodology for each subgroup, aimed at selecting the optimal random walk model
Changes in the number of maternal deaths attributed to all causes, direct causes, and indirect causes associated with aging, epidemiological change, and population from 1990 to 2021 and 1990 to 2050
Age-standardized maternal mortality ratios by cause (all, direct, indirect) among individuals aged 15–19 years across 78 countries for the global population, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red.
Age-standardized maternal mortality ratios by cause (all, direct, indirect) among individuals aged 20–24 years across 37 countries for the global population, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red.
Age-standardized maternal mortality ratios by cause (all, direct, indirect) among individuals aged 25–29 years across 37 countries for the global population, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red.
Age-standardized maternal mortality ratios by cause (all, direct, indirect) among individuals aged 30–34 years across 37 countries for the global population, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red.
Age-standardized maternal mortality ratios by cause (all, direct, indirect) among individuals aged 35–39 years across 37 countries for the global population, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red.
Age-standardized maternal mortality ratios by cause (all, direct, indirect) among individuals aged 40–44 years across 37 countries for the global population, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red.
Age-standardized maternal mortality ratios by cause (all, direct, indirect) among individuals aged 45–49 years across 37 countries for the global population, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red.
Age-standardized all causes of maternal mortality ratio among individuals aged 15–19 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized all causes of maternal mortality ratio among individuals aged 20–24 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized all causes of maternal mortality ratio among individuals aged 25–29 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized all causes of maternal mortality ratio among individuals aged 30–34 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized all causes of maternal mortality ratio among individuals aged 35–39 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized all causes of maternal mortality ratio among individuals aged 40–44 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized all causes of maternal mortality ratio among individuals aged 45–49 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized direct causes of maternal mortality ratio across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized direct causes of maternal mortality ratio among individuals aged 15–19 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized direct causes of maternal mortality ratio among individuals aged 20–24 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized direct causes of maternal mortality ratio among individuals aged 25–29 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized direct causes of maternal mortality ratio among individuals aged 30–34 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized direct causes of maternal mortality ratio among individuals aged 35–39 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized direct causes of maternal mortality ratio among individuals aged 40–44 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized direct causes of maternal mortality ratio among individuals aged 45–49 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized indirect causes of maternal mortality ratio across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized indirect causes of maternal mortality ratio among individuals aged 15–19 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized indirect causes of maternal mortality ratio among individuals aged 15–19 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized indirect causes of maternal mortality ratio among individuals aged 25–29 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized indirect causes of maternal mortality ratio among individuals aged 30–34 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized indirect causes of maternal mortality ratio among individuals aged 35–39 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized indirect causes of maternal mortality ratio among individuals aged 40–44 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized indirect causes of maternal mortality ratio among individuals aged 45–49 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
LOESS smoothed maternal mortality ratio attributed to all causes, direct causes, and indirect causes by sex and age group among 8 countries in Asia-Pacific, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore.
LOESS smoothed maternal mortality ratio attributed to all causes, direct causes, and indirect causes by sex and age group among 21 countries in Europe, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom.
LOESS smoothed maternal mortality ratio attributed to all causes, direct causes, and indirect causes by sex and age group among 6 countries in Latin America and the Caribbean, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay.
LOESS smoothed maternal mortality ratio attributed to all causes, direct causes, and indirect causes by sex and age group among 2 countries in North America, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. North America includes 2 countries, including Canada and the United States of America.
Correlation between age-standardized direct causes maternal mortality ratio and human development index, socio-demographic index, UHC service index, and Gini coefficient.
Correlation between age-standardized indirect causes maternal mortality ratio and human development index, socio-demographic index, UHC service index, and Gini coefficient.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER)
Age-standardized mortality rate calculation, socio-economic indicators, and advanced statistical methods
Maternal mortality ratio by various causes ICD-9 and ICD-10 code list
List of 37 countries along with their corresponding 3 letter codes
Classification of countries into continent groups
LOESS smoothed all causes for maternal mortality ratio (per 100,000 live births) in 37 countries, 1990–2021
LOESS smoothed all causes for maternal mortality ratio (per 100,000 live births) among individuals aged 15–19 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal mortality ratio (per 100,000 live births) among individuals aged 20–24 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal mortality ratio (per 100,000 live births) among individuals aged 25–29 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal mortality ratio (per 100,000 live births) among individuals aged 30–34 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal mortality ratio (per 100,000 live births) among individuals aged 35–39 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal mortality ratio (per 100,000 live births) among individuals aged 40–44 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal mortality ratio (per 100,000 live births) among individuals aged 45–49 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal mortality ratio (per 100,000 live births) in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal mortality ratio (per 100,000 live births) among individuals aged 15–19 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal mortality ratio (per 100,000 live births) among individuals aged 20–24 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal mortality ratio (per 100,000 live births) among individuals aged 25–29 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal mortality ratio (per 100,000 live births) among individuals aged 30–34 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal mortality ratio (per 100,000 live births) among individuals aged 35–39 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal mortality ratio (per 100,000 live births) among individuals aged 40–44 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal mortality ratio (per 100,000 live births) among individuals aged 45–49 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal mortality ratio (per 100,000 live births) in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal mortality ratio (per 100,000 live births) among individuals aged 15–19 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal mortality ratio (per 100,000 live births) among individuals aged 20–24 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal mortality ratio (per 100,000 live births) among individuals aged 25–29 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal mortality ratio (per 100,000 live births) among individuals aged 30–34 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal mortality ratio (per 100,000 live births) among individuals aged 35–39 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal mortality ratio (per 100,000 live births) among individuals aged 40–44 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal mortality ratio (per 100,000 live births) among individuals aged 45–49 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal YLLs ratio (per 100,000 live births) in 37 countries, 1990–2021
LOESS smoothed all causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 15–19 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 20–24 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 25–29 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 30–34 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 35–39 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 40–44 years in 37 countries, 1990–2021
LOESS smoothed all causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 45–49 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal YLLs ratio (per 100,000 live births) in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 15–19 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 20–24 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 25–29 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 30–34 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 35–39 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 40–44 years in 37 countries, 1990–2021
LOESS smoothed direct causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 45–49 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal YLLs ratio (per 100,000 live births) in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 15–19 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 20–24 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 25–29 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 30–34 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 35–39 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 40–44 years in 37 countries, 1990–2021
LOESS smoothed indirect causes for maternal YLLs ratio (per 100,000 live births) among individuals aged 45–49 years in 37 countries, 1990–2021
The age-standardized maternal mortality ratio (95% credible intervals) at the national level is estimated for 2030, 2040, and 2050 using Bayesian age-period-cohort models, categorized by continent
Hyperparameter estimates of age, period, and cohort effects calculated by Bayesian age-period-cohort models for trends in various causes of mortality ratio by continent using data from 1990 to 2021 are provided
Projection performance results of the Bayesian age-period-cohort model, evaluated using the root mean square error methodology for each subgroup, aimed at selecting the optimal random walk model
Changes in the number of maternal deaths attributed to all causes, direct causes, and indirect causes associated with aging, epidemiological change, and population from 1990 to 2021 and 1990 to 2050
Age-standardized maternal mortality ratios by cause (all, direct, indirect) among individuals aged 15–19 years across 78 countries for the global population, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red.
Age-standardized maternal mortality ratios by cause (all, direct, indirect) among individuals aged 20–24 years across 37 countries for the global population, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red.
Age-standardized maternal mortality ratios by cause (all, direct, indirect) among individuals aged 25–29 years across 37 countries for the global population, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red.
Age-standardized maternal mortality ratios by cause (all, direct, indirect) among individuals aged 30–34 years across 37 countries for the global population, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red.
Age-standardized maternal mortality ratios by cause (all, direct, indirect) among individuals aged 35–39 years across 37 countries for the global population, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red.
Age-standardized maternal mortality ratios by cause (all, direct, indirect) among individuals aged 40–44 years across 37 countries for the global population, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red.
Age-standardized maternal mortality ratios by cause (all, direct, indirect) among individuals aged 45–49 years across 37 countries for the global population, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red.
Age-standardized all causes of maternal mortality ratio among individuals aged 15–19 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized all causes of maternal mortality ratio among individuals aged 20–24 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized all causes of maternal mortality ratio among individuals aged 25–29 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized all causes of maternal mortality ratio among individuals aged 30–34 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized all causes of maternal mortality ratio among individuals aged 35–39 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized all causes of maternal mortality ratio among individuals aged 40–44 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized all causes of maternal mortality ratio among individuals aged 45–49 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized direct causes of maternal mortality ratio across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized direct causes of maternal mortality ratio among individuals aged 15–19 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized direct causes of maternal mortality ratio among individuals aged 20–24 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized direct causes of maternal mortality ratio among individuals aged 25–29 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized direct causes of maternal mortality ratio among individuals aged 30–34 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized direct causes of maternal mortality ratio among individuals aged 35–39 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized direct causes of maternal mortality ratio among individuals aged 40–44 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized direct causes of maternal mortality ratio among individuals aged 45–49 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized indirect causes of maternal mortality ratio across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized indirect causes of maternal mortality ratio among individuals aged 15–19 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized indirect causes of maternal mortality ratio among individuals aged 15–19 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized indirect causes of maternal mortality ratio among individuals aged 25–29 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized indirect causes of maternal mortality ratio among individuals aged 30–34 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized indirect causes of maternal mortality ratio among individuals aged 35–39 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized indirect causes of maternal mortality ratio among individuals aged 40–44 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
Age-standardized indirect causes of maternal mortality ratio among individuals aged 45–49 years across 37 countries for the global and populations across four continents, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay. North America includes 2 countries, including Canada and the United States of America.
LOESS smoothed maternal mortality ratio attributed to all causes, direct causes, and indirect causes by sex and age group among 8 countries in Asia-Pacific, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Asia Pacific includes 8 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, and Singapore.
LOESS smoothed maternal mortality ratio attributed to all causes, direct causes, and indirect causes by sex and age group among 21 countries in Europe, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Europe includes 21 countries, including Australia, Brunei Darussalam, Hong Kong SAR, Israel, Japan, New Zealand, the Republic of Korea, Singapore, Austria, Belgium, Croatia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom.
LOESS smoothed maternal mortality ratio attributed to all causes, direct causes, and indirect causes by sex and age group among 6 countries in Latin America and the Caribbean, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. Latin America and the Caribbean include 6 countries, including Bahamas, Chile, Panama, Puerto Rico, Trinidad and Tobago, and Uruguay.
LOESS smoothed maternal mortality ratio attributed to all causes, direct causes, and indirect causes by sex and age group among 2 countries in North America, 1990–2021. The LOESS mortality rates with 95% confidence levels are shown in red. North America includes 2 countries, including Canada and the United States of America.
Correlation between age-standardized direct causes maternal mortality ratio and human development index, socio-demographic index, UHC service index, and Gini coefficient.
Correlation between age-standardized indirect causes maternal mortality ratio and human development index, socio-demographic index, UHC service index, and Gini coefficient.