Global Maternal Mortality Attributed to Maternal Hemorrhage and Its Socioeconomic Disparities

Maternal hemorrhage (MH) remains a leading preventable cause of maternal health, yet global disparities on its burden remain poorly quantified. Using the Global Burden of Disease 2021 data, we analyzed global, regional, and national trends in age-standardized maternal mortality ratio (ASR_MMR) attributed to MH from 1990 to 2021. We applied Joinpoint regression, age–period–cohort modeling, inequality indices and frontier analysis. This descriptive–analytical ecological study is based on modeled secondary data. Globally, the proportion of ASR_MMR attributed to MH declined from 33.31% in 1990 to 24.52% in 2021 (relative reduction: 24.24%). ASR_MMR attributed to MH consistently declined, with an estimated annual percentage change (EAPC) of −3.17 (95% UI: −3.42, −2.91). In 2021, Central and West Africa countries reported ASR_MMR attributed to MH exceeding 300 per 100,000 live births, while the Caribbean experienced a temporary increase. ASR_MMR attributed to MH was strongly inversely correlated with the socio-demographic index (SDI). Absolute inequality (slope index of inequality) narrowed by 49.4%, while relative inequality (concentration index) increased by approximately 27.5%. Countries with the largest negative deviations from the frontier included Somalia, the Central African Republic, Chad, Nigeria, and Afghanistan. While substantial global progress has been made, socioeconomic inequities continue to drive persistent disparities in MMR attributed to MH. Policies must not only address average reductions but also the widening relative gap between advantaged and disadvantaged populations.