“While pregnancy should be a time of immense hope and a positive experience for all women, it is tragically still a shockingly dangerous experience for millions around the world who lack access to high quality, respectful health care,” World Health Organization Director General Tedros Adhanom Ghebreyesus said in a news release about the report, released Thursday.

Severe bleeding, high blood pressure, pregnancy-related infections, complications from unsafe abortions, and underlying medical conditions that can be aggravated by pregnancy (like HIV/AIDS and malaria) are the top causes of maternal death, according to the report. All such conditions are “largely preventable and treatable with access to high-quality and respectful health care,” the authors noted.

Maternal mortality increased in Europe and North America from 2016 through 2020, by 17% and 15%, respectively, according to the report. Rates stagnated in four regions, and declined in two others—Australia and New Zealand; central and southern Asia—by 35% and 16%, respectively, during the same period.

The pandemic may have adversely impacted those numbers, the authors wrote, noting that COVID increases risks of pregnancy complications. They encouraged vaccination for pregnant women and women planning to become pregnant.

Worldwide, there were an estimated 287,000 maternal deaths in 2020, down only slightly from the estimated 309,000 in 2016. While gains were made in reducing maternal mortality from 2000 through 2015, those gains largely stalled, or even reversed, afterward, according to the report.

Maternal deaths tend to be concentrated in the poorest countries, and in areas experiencing conflict. In 2020, roughly 70% of global maternal deaths occurred in sub-Saharan Africa. And in countries facing severe humanitarian crises, maternal mortality rates were more than double the world average, the authors wrote.