Divergent Epidemiology of Maternal Mortality in Sub‐Saharan Africa: The Case for Differentiated Regional Strategies to Achieve 2030
SDG
Targets
Amadou Barrow, Friday E. Okonofua, Anne Baber Wallis ABSTRACT
Background
Despite global efforts, sub‐Saharan Africa continues to account for 70% of maternal deaths, yet systematic cause‐specific analyses across African regions remain limited. We examined 33‐year trends in maternal mortality to identify epidemiologic divergence and guide differentiated intervention strategies.
Methods
Using the 2023 Global Burden of Disease Study, maternal mortality ratios (MMR), cause‐specific deaths, and age‐specific patterns were analysed across five African regions (Central, Eastern, Northern, Southern, and Western Africa) from 1990 to 2023. Absolute and relative changes, average annual rates of change, cause‐specific mortality proportions, and progress against Sustainable Development Goal targets were assessed.
Results
MMR reduction varied dramatically across regions. Northern Africa achieved the greatest decline (65.0%; 241.2 to 84.4 per 100,000 live births), while Central Africa achieved only 16.7% reduction (818.1 to 681.3). Cause‐specific patterns diverged strikingly: HIV‐related causes accounted for 87.3% of maternal deaths in Southern Africa versus 34.2% in Central Africa, while direct obstetric causes showed inverse patterns (6.3% vs. 39.9%). HIV‐related maternal deaths increased 76%–454% across most regions despite antiretroviral therapy (ART) scale‐up. Age‐extreme populations faced 1.3‐ to 7.2‐fold elevated risks; adolescents in Central Africa had an MMR of 852.3, and women aged 45–49 years reached 2233.0. Central Africa's MMR remained 3.6 times the global average, with sepsis burden (15.3%) more than double other regions (4%–7%).
Conclusion
African regions demonstrate distinct epidemiologic profiles requiring tailored intervention strategies. Universal maternal health approaches inadequately address HIV‐dominant versus obstetric‐dominant regional burdens or age‐extreme vulnerability. Central Africa's minimal progress signals that standard interventions fail under protracted humanitarian crises. Post‐2025 strategies must integrate linked HIV‐maternal care, emergency obstetric services, crisis‐adapted approaches, and age‐targeted programming while recognizing within‐region heterogeneity to achieve equitable maternal health outcomes.