{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T11:32:11Z","timestamp":1786447931724,"version":"build-2736575974"},"reference-count":37,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Women's Health Reports"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Worldwide, lowering maternal mortality is a top priority. While significant efforts have been made to address direct obstetric complications, indirect causes such as pre-existing medical conditions that are aggravated by pregnancy remain a major cause of mortality but are often unrecognized. Understanding indirect maternal mortality prevalence and patterns is crucial for creating focused interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Data were explored from the Global Burden of Disease (GBD) study 2021. Maternal mortality ratio (MMR), maternal mortality rate (MM Rate), disability-adjusted life years (DALYs), and years of life lost (YLLs) were extracted and analyzed. Age-standardized rates and estimated annual percentage change were calculated to evaluate temporal trends. Data visualization and trend analysis were conducted using GBD Compare, Cause of Death Visualization, and GBD Foresight Visualization tools. Microsoft Excel was used for additional data organization and statistical summarization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result:<\/jats:title>\n                    <jats:p>The analysis revealed a global declining trend in indirect maternal mortality, as measured by the MM Rate, MMR, DALYs, and YLLs. The MM Rate decreased from 3.59 (95% uncertainty interval [UI]: 3.11, 4.14) per 100,000 women of reproductive age in 1980 to 0.97 (95% UI: 0.83, 1.13) in 2021, while the MMR declined from 31.49 (95% UI: 27.23, 36.24) to 14.67 (95% UI: 12.64, 17.07) per 100,000 live births over the same period. Indirect maternal deaths and DALYs were most prominent among women aged 25\u201329 and 30\u201334 years. The death rates in these age groups were 1.3 and 1.28 per 100,000 women, respectively, with corresponding DALY rates of 81.87 (95% UI: 70.2, 96.15) and 73.89 (95% UI: 63.03, 85.58).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This analysis demonstrates a significant global decline in indirect maternal mortality from 1980 to 2021, reflected in reductions in the MMR, MM Rate, DALYs, and YLLs. Although global maternal mortality has declined, substantial variation continues across countries and regions, with the highest burden in low- and middle-income countries. Notably, some high-income countries have experienced increases since 1980. This signals a global health concern that demands urgent attention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/26884844261475865","type":"journal-article","created":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T12:20:35Z","timestamp":1786191635000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Hidden Burden: Global, Regional, and National Trends in Indirect Cause of Maternal Mortality from 1980 to 2021: A Global Analysis Using the Global Burden of Disease 2021 Data"],"prefix":"10.1177","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6342-9636","authenticated-orcid":false,"given":"Abebaw","family":"Alamrew","sequence":"first","affiliation":[{"name":"Department of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chalie","family":"Mulugeta","sequence":"additional","affiliation":[{"name":"Department of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayinalem","family":"Yetwale","sequence":"additional","affiliation":[{"name":"Department of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadele","family":"Emagneneh","sequence":"additional","affiliation":[{"name":"Department of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mulat","family":"Ayele","sequence":"additional","affiliation":[{"name":"Department of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyob Shitie","family":"Lake","sequence":"additional","affiliation":[{"name":"Department of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esuyawkal","family":"Mislu","sequence":"additional","affiliation":[{"name":"Department of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,8]]},"reference":[{"key":"e_1_3_5_2_1","volume-title":"Trends in maternal mortality estimates 2000 to 2023: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division","author":"Organization WH, (UNICEF) UNCF, Fund UNP, Bank W, United Nations Department of Economic and Social Affairs PD","year":"2025","unstructured":"1.Organization WH, (UNICEF) UNCF, Fund UNP, Bank W, United Nations Department of Economic and Social Affairs PD. Trends in maternal mortality estimates 2000 to 2023: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division. World Health Organization: Geneva; 2025."},{"key":"e_1_3_5_3_1","volume-title":"Trends in Maternal Mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division","author":"Organization WH","year":"2023","unstructured":"2.Organization WH. Trends in Maternal Mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division. World Health Organization; 2023."},{"key":"e_1_3_5_4_1","unstructured":"3.Affairs UND of E and S. The sustainable development goals report 2023: Special edition. UN; 2023."},{"key":"e_1_3_5_5_1","volume-title":"Strategies Towards Ending Preventable Maternal Mortality (EPMM): Executive Summary","author":"Organization WH","year":"2015","unstructured":"4.Organization WH. Strategies towards ending preventable maternal mortality (EPMM): Executive Summary. 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