Socioeconomic and Demographic Correlates of Maternal Mortality: A Cross-National Ecological Study

Introduction

The maternal mortality rate(MMR) reflects a nation’s healthcare capacity and socioeconomic development. This study investigates the associations between MMR and various socioeconomic and demographic indicators across 180 countries.

Methods

This ecological study utilizes national-level data from 180 countries(centered on 2019), retrieved from ‘Our World in Data’. Relationships were assessed using Pearson Correlation. Significant variables were included in a backward multiple linear regression model with a threshold of p < 0.20.

Results

Bivariate correlations indicated higher MMR is associated with higher adolescent birth rates(r = 0.734, p < 0.001), children born per woman(r = 0.767, p < 0.001), and income inequality(r = 0.205, p = 0.009). Conversely, MMR correlates negatively with HDI(r= -0.232, p = 0.002), Corruption Perception Index(r= -0.495, p < 0.001), literacy(r= -0.748,p< 0.001), GDP per capita (r= -0.476, p < 0.001), health expenditures(r= -0.520, p < 0.001), skilled birth attendance(r= -0.752, p < 0.001) and women’s political empowerment(r= -0.303, p < 0.001). Multiple regression revealed the number of children per woman was positively associated with MMR(B = 72.218, p < 0.001), whereas skilled birth attendance(B= -3.235, p < 0.001) and literacy (B= -2.101, p = 0.035) showed significant negative associations. Conversely, no statistically significant association was found between the maternal mortality rate and either the Corruption Perceptions Index(p = 0.066) or women’s political empowerment(p = 0.158).

Conclusions

Consequently, macro-level public health strategies prioritizing female educational attainment and addressing factors related to adolescent pregnancies may be important focal points for maternal health policies. Furthermore, the strong association found with skilled birth attendance highlights the potential value of expanding healthcare infrastructure and deploying qualified personnel, particularly in countries facing significant income inequality.

Key messages

• Globally, maternal mortality is significantly positively associated with births per woman, and negatively associated with literacy rates and skilled birth attendance.

• Our model shows skilled birth attendance outweighs general health spending, highlighting allocative efficiency: how health funds are directed matters more than absolute budget size.