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Research papers on Maternal mortality

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  1. Reducing Disparities in Severe Maternal Morbidity and Mortality

    ELIZABETH A. HOWELL · 2018 · Clinical Obstetrics & Gynecology · 687 citations

    Significant racial and ethnic disparities in maternal morbidity and mortality exist in the United States. Black women are 3 to 4 times more likely to die a pregnancy-related death as compared with white women. Growing research indicates that quality of health care, from preconception through postpartum care, may be a critical lever for improving outcomes for racial and ethnic minority women. This article reviews racial and ethnic disparities in severe maternal morbidities and mortality, underlying drivers of these disparities, and potential levers to reduce their occurrence.

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  2. A global analysis of the determinants of maternal health and transitions in maternal mortality

    João Paulo Souza, Louise T. Day, Ana Clara Rezende-Gomes, et al. · 2023 · The Lancet Global Health · 403 citations

    The reduction of maternal mortality and the promotion of maternal health and wellbeing are complex tasks. This Series paper analyses the distal and proximal determinants of maternal health, as well as the exposures, risk factors, and micro-correlates related to maternal mortality. This paper also examines the relationship between these determinants and the gradual shift over time from a pattern of high maternal mortality to a pattern of low maternal mortality (a phenomenon described as the maternal mortality transition). We conducted two systematic reviews of the literature and we analysed publicly available data on indicators related to the Sustainable Development Goals, specifically, estim

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  4. Maternal Mortality in the United States

    K.S. Joseph, Amélie Boutin, Sarka Lisonkova, et al. · 2021 · Obstetrics and Gynecology · 142 citations

    Rigorous studies carried out by the National Center for Health Statistics show that previously reported increases in maternal mortality rates in the United States were an artifact of changes in surveillance. The pregnancy checkbox, introduced in the revised 2003 death certificate and implemented by the states in a staggered manner, resulted in increased identification of maternal deaths and in reported maternal mortality rates. This Commentary summarizes the findings of the National Center for Health Statistics reports, describes temporal trends and the current status of maternal mortality in the United States, and discusses future concerns. Although the National Center for Health Statistics

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  5. A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality

    Rada K. Dagher, Deborah E. Linares · 2022 · Children · 118 citations

    BACKGROUND: U.S. maternal and infant mortality rates constitute an important public health problem, because these rates surpass those in developed countries and are characterized by stark disparities for racial/ethnic minorities, rural residents, and individuals with less privileged socioeconomic status due to social determinants of health (SDoH). METHODS: A critical review of the maternal and infant mortality literature was performed to determine multilevel SDoH factors leading to mortality disparities with a life course lens. RESULTS: Black mothers and infants fared the worst in terms of mortality rates, likely due to the accumulation of SDoH experienced as a result of structural racism ac

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  6. Levels and determinants of maternal mortality in northern and southern Nigeria

    Catherine Meh, Amardeep Thind, Bridget L. Ryan, et al. · 2019 · BMC Pregnancy and Childbirth · 110 citations

    BACKGROUND: Maternal mortality is still a major risk for women of childbearing age in Nigeria. In 2008, Nigeria bore 14% of the global burden of maternal mortality. The national maternal mortality ratio has remained elevated despite efforts to reduce maternal deaths. Though health disparities exist between the North and South of Nigeria, there is a dearth of evidence on the estimates and determinants of maternal mortality for these regions. METHODS: This study aimed to assess differences in the levels and determinants of maternal mortality in women of childbearing age (15-49 years) in the North and South of Nigeria. The Nigeria Demographic and Health Surveys (2008 and 2013) were used. The as

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  8. Disparities and determinants of maternal health services utilization among women in poverty-stricken rural areas of China: a cross-sectional study

    Yuxuan Yang, Min Yu · 2023 · BMC Pregnancy and Childbirth · 34 citations

    Background Reducing maternal mortality ratio (MMR) has been a worldwide public health challenge for a long time. Utilization of maternal health services including antenatal care (ANC), institutional delivery (ID), and postnatal care (PNC) is vital to prevent maternal mortality. China has made significant improvements in maternal health during the past 30 years, however, disparities in maternal health service utilization still exist among regions and the western rural areas had the lowest utilization rate. This study aims to assess the inequality and determinants of maternal health service utilization in western poverty-stricken rural areas based on Anderson’s Behavioral Model of Health Servi

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  9. Disparities in pregnancy-related deaths: spatial and Bayesian network analyses of maternal mortality ratio in 54 African countries

    S. Yaya, S. Anjorin, S. Adedini · 2021 · BMJ Global Health · 33 citations

    Background Maternal mortality remains a public health problem despite several global efforts. Globally, about 830 women die of pregnancy-related death per day, with more than two-third of these cases occurring in Africa. We examined the spatial distribution of maternal mortality in Africa and explored the influence of SDoH on the spatial distribution. Methods We used country-level secondary data of 54 African countries collected between 2006 and 2018 from three databases namely, World Development Indicator, WHO’s Global Health Observatory Data and Human Development Report. We performed descriptive analyses, presented in tables and maps. The spatial analysis involved local indicator of spatia

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  10. Geographic disparities and determinants of full utilization of the continuum of maternal and newborn healthcare services in rural India

    Pooja Tripathi, Mahashweta Chakrabarty, Aditya Singh, et al. · 2024 · BMC Public Health · 27 citations

    To further reduce maternal and neonatal mortality, it is essential for mothers and newborns to fully utilize all essential services within the continuum of maternal and newborn care. However, research on maternal and child health services in India has not sufficiently examined geographical disparities in the full utilization of these services and the factors influencing the full utilization, particularly in rural areas. This study aims to address this critical gap. Utilizing data from 130,312 mothers collected in the National Family Health Survey-5 (2019–21), this study employed spatial analysis to uncover geographical disparities in the full utilization of the continuum of maternal and newb

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  11. Under-five mortality and social determinants in africa: a systematic review

    Israel C. Avelino, J. Van-Dúnem, L. Varandas · 2025 · European Journal of Pediatrics · 24 citations

    Under-five mortality is a key public health indicator, highly responsive to preventive interventions. While global efforts have made strides in reducing mortality rates in this age group, significant disparities persist, particularly in Sub-Saharan Africa. This study aimed to systematically review the factors influencing under-five mortality in Africa, focusing on sociodemographic factors and health-related determinants. A systematic review was conducted adhering to PRISMA guidelines. Studies were identified from a range of well-established indexed academic databases. Keywords and Boolean operators facilitated relevant study retrieval. Only articles published in English, Portuguese, or Spani

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  12. Global, regional, and national levels of maternal mortality, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

    Ye Wei, Hong Luo, Xiaoyu Liu, et al. · 2025 · BMC Pregnancy and Childbirth · 13 citations

    Despite global declines in the maternal mortality ratio (MMR), significant disparities persist across regions and socioeconomic strata. This study aims to examine spatiotemporal trends in MMR from 1990 to 2021, with a specific breakdown by age, socio-demographic index (SDI) and cause of death, to better clarify the underlying determinants of these patterns. Utilizing data from the Global Burden of Disease (GBD) Study 2021, we examined MMR trends attributable to ten distinct causes across 204 countries and territories from 1990 to 2021. Analyses were stratified by the SDI, and temporal patterns in age-specific and regional MMR distribution were evaluated. The global MMR declined from 260.02 p

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  13. Rural hospital and obstetric unit closures as social determinants of racial and ethnic maternal health disparities: A scoping review.

    Jessica G. Smith, K. Brown · 2023 · Journal of advanced nursing · 12 citations

    AIMS To synthesize literature examining (1) rural hospital or obstetric unit closures as a social determinant of maternal/infant health outcomes and (2) closures as a social determinant of racial/ethnic disparities in maternal/infant health outcomes. DESIGN Scoping review. DATA SOURCES MEDLINE, OVID/Embase and CINAHL were searched systematically to identify sources from 31 July 2003 to 31 July 2023. The Arksey and O'Malley methodology for scoping reviews was used. RESULTS Four studies from the United States and Australia documented the impact of rural hospital or obstetric unit closures on maternal/infant health outcomes, such as increased births in hospitals without obstetric units, o

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  14. Disparities in Diabetes in Pregnancy and the Role of Social Determinants of Health

    L. Dickens · 2025 · Current Diabetes Reports · 12 citations

    The rates of diabetes in pregnancy (type 1, type 2, and gestational diabetes) are increasing. Diabetes in pregnancy is associated with increased risk for maternal and neonatal complications. Certain groups are disproportionately affected by these complications and this paper reviews the data about disparities in diabetes in pregnancy and explores the social determinants of health (SDoH) underlying these disparities. Rates of diagnosis of gestational diabetes and pregestational diabetes are higher in racial and ethnic minority groups and people with socioeconomic disadvantage. There is higher all cause maternal mortality for Black people compared to White people. Emerging data suggests higher

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  15. Multilevel determinants of racial/ethnic disparities in severe maternal morbidity and mortality in the context of the COVID-19 pandemic in the USA: protocol for a concurrent triangulation, mixed-methods study

    Jihong Liu, Peiyin Hung, Chen Liang, et al. · 2022 · BMJ Open · 11 citations

    INTRODUCTION: The COVID-19 pandemic has affected communities of colour the hardest. Non-Hispanic black and Hispanic pregnant women appear to have disproportionate SARS-CoV-2 infection and death rates. METHODS AND ANALYSIS: We will use the socioecological framework and employ a concurrent triangulation, mixed-methods study design to achieve three specific aims: (1) examine the impacts of the COVID-19 pandemic on racial/ethnic disparities in severe maternal morbidity and mortality (SMMM); (2) explore how social contexts (eg, racial/ethnic residential segregation) have contributed to the widening of racial/ethnic disparities in SMMM during the pandemic and identify distinct mediating pathways t

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  16. How did Nepal Reduce the Maternal Mortality? A Result from Analysing the Determinants of Maternal Mortality

    R Karkee · 2012 · Journal of Nepal Medical Association · 11 citations

    Nepal reportedly reduced the maternal mortality ratio by 48% within one decade between 1996-2005 and received the Millennium development goal award for this. However, there is debate regarding the accuracy of this figure. On the basis of framework of determinants of maternal mortality proposed by McCarthy and Maine in 1992 and successive data from Nepal demographic health survey of 1996, 2001 and 2006, a literature analysis was done to identify the important factors behind this decline. Although facility delivery and skilled birth attendants are acclaimed as best strategy of reducing maternal mortality, a proportionate increase in these factors was not found to account the maternal mortality

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  17. Disparities in maternal mortality

    Phuong Tran, Barbara Jreij, Farideh Sistani, et al. · 2023 · Journal of Clinical and Translational Science · 10 citations

    Maternal mortality rates in the USA remain high, with persistent racial and socioeconomic disparities. We identified 207,016 hospital admissions for pregnant women in Maryland, from 2017 to 2019. Logistic regression was used to identity factors associated with maternal death. The health outcome for black women was more prone to give rise to maternal mortality than for white women. Our study revealed numerous racial and age discrepancies in gestational health outcomes, which opioid use disorder exacerbated. Our findings elaborate on the importance of identifying the drivers of adverse pregnancy outcomes, to help inform policy, and resource allocations.

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  18. Addressing Racial Disparities in Pregnancy-Related Deaths: An Analysis of Maternal Mortality-Related Federal Legislation, 2017 – 2021

    D. Carty, J. Mpofu, Alissa C. Kress, et al. · 2022 · Journal of women's health (2002) · 9 citations

    There has been increasing national attention to the issue of racial disparities in pregnancy-related deaths. Federal legislation can support approaches at multiple levels of intervention to improve maternal health. As part of the CDC Policy Academy, a team of CDC staff completed a policy analysis to determine the approaches addressed in federal legislation to reduce racial disparities in pregnancy-related deaths. We analyzed federal maternal mortality legislation introduced January 2017 through December 2021. Common approaches addressed by the legislation were categorized into themes and reviewed for their alignment with approaches identified in clinical and public health literature to reduc

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  19. Regional Disparities and Maternal Sociodemographic Determinants of Full Immunization Coverage Among Children Aged 12–23 Months in Nigeria: Insights from NDHS 2018

    Jamilu Sani, S. Halane, M. M. Ahmed, et al. · 2025 · Pediatric Health, Medicine and Therapeutics · 8 citations

    Background Childhood immunization is crucial for reducing morbidity and mortality from vaccine-preventable diseases. Despite global efforts, Nigeria faces persistently low immunization uptake with significant regional and socioeconomic disparities. This study investigated the prevalence, regional disparities, and sociodemographic determinants of full immunization coverage among children aged 12–23 months in Nigeria. Methods This secondary analysis utilized data from the 2018 Nigeria Demographic and Health Survey (NDHS), focusing on 2453 mothers with children aged 12–23 months. Full immunization coverage was defined per World Health Organization (WHO) guidelines. Descriptive statistics, bivar

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  20. Conceptualizing Social Determinants of Maternal and Infant Health Disparities

    Susanne Klawetter · 2014 · Affilia · 8 citations

    Research demonstrates that women and children within marginalized ethnic and racial groups and those living in poverty experience disparate health outcomes. These disparities have immediate and long-term consequences. Exploring two theories used to examine social determinants of health—life course perspective and historical trauma response, this article will explain the major premises of each, provide application examples, compare and examine utility for practice, and highlight areas for future research. A theoretical critique will be included, as well as insight into how these theories together might address gaps as an approach to maternal and infant health research and practice.

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  22. Racial and Ethnic Disparities in Delivery In-Hospital Mortality or Maternal End-Organ Injury: A Multistate Analysis, 2007–2020

    Robert S. White, V. Tangel, B. Lui, et al. · 2023 · Journal of Women's Health · 4 citations

    Background: In the United States, Black maternal mortality is 2–4 × higher than that of White maternal mortality, with differences also present in severe maternal morbidity and other measures. However, limited research has comprehensively studied multilevel social determinants of health, and their confounding and effect modification on obstetrical outcomes. Materials and Methods: We performed a retrospective multistate analysis of adult inpatient delivery hospitalizations (Florida, Kentucky, Maryland, New Jersey, New York, North Carolina, and Washington) between 2007 and 2020. Multilevel multivariable models were used to test the confounder-adjusted association for race/ethnicity and the bin

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  24. Maternal mortality in Ethiopia (2015–2025): a systematic review of recent evidence and determinants

    Merga Abdissa Aga, Ding-Geng Chen · 2025 · BMC Public Health · 3 citations

    Despite major policy reforms and improvements in healthcare coverage, maternal mortality remains a critical public health burden in Ethiopia. While progress has been made since the Millennium Development Goals era, the maternal mortality ratio (MMR) still exceeds national and global targets. This systematic review synthesizes evidence from the past decade (2015–2025) to describe the magnitude, determinants, and regional disparities of maternal mortality in Ethiopia, highlighting persistent challenges and future priorities. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (registered in International Prospective Register of Systematic R

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