Data for the causes of maternal deaths are needed to inform policies to improve maternal
health. We developed and analysed global, regional, and subregional estimates of the
causes of maternal death during 2003-09, with a novel method, updating the previous
WHO systematic review.
We searched specialised and general bibliographic databases for articles published
between between Jan 1, 2003, and Dec 31, 2012, for research data, with no language
restrictions, and the WHO mortality database for vital registration data. On the basis
of prespecified inclusion criteria, we analysed causes of maternal death from datasets.
We aggregated country level estimates to report estimates of causes of death by Millennium
Development Goal regions and worldwide, for main and subcauses of death categories
with a Bayesian hierarchical model.
We identified 23 eligible studies (published 2003-12). We included 417 datasets from
115 countries comprising 60 799 deaths in the analysis. About 73% (1 771 000 of 2 443 000)
of all maternal deaths between 2003 and 2009 were due to direct obstetric causes and
deaths due to indirect causes accounted for 27·5% (672 000, 95% UI 19·7-37·5) of all
deaths. Haemorrhage accounted for 27·1% (661 000, 19·9-36·2), hypertensive disorders
14·0% (343 000, 11·1-17·4), and sepsis 10·7% (261 000, 5·9-18·6) of maternal deaths.
The rest of deaths were due to abortion (7·9% [193 000], 4·7-13·2), embolism (3·2%
[78 000], 1·8-5·5), and all other direct causes of death (9·6% [235 000], 6·5-14·3).
Regional estimates varied substantially.
Between 2003 and 2009, haemorrhage, hypertensive disorders, and sepsis were responsible
for more than half of maternal deaths worldwide. More than a quarter of deaths were
attributable to indirect causes. These analyses should inform the prioritisation of
health policies, programmes, and funding to reduce maternal deaths at regional and
global levels. Further efforts are needed to improve the availability and quality
of data related to maternal mortality.
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