Learning from Maternal Mortality Confidential Enquiries: Sociodemographic Determinants Relevant to Equitable Guideline Development

Background Confidential enquiry systems are central to maternal mortality surveillance, transforming individual case reviews into actionable lessons to improve clinical practice. While some high-income countries have established national confidential enquiry systems, no comparative synthesis has examined the sociodemographic determinants of maternal mortality reported across these systems. This study reviewed confidential enquiry reports from high-income populations to assess variation in reporting of sociodemographic determinants associated with maternal mortality and to develop country-specific equity checklists to support guideline development. Methods: High-income populations were identified using the World Bank Group classification (July 2025). Each country was searched using a structured approach for the most recent publicly available Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE) equivalent English-language report. Surveillance characteristics and sociodemographic determinants associated with maternal mortality were extracted and country-specific equity checklists were subsequently developed from determinants identified in each report. Results Eighty-five high-income populations were identified. Sixteen had publicly available national confidential enquiry reports in English. Country-specific equity checklists were developed for each of these 16-world bank listed populations. The included surveillance reports demonstrated substantial variation in maturity, case ascertainment, review methodology and scope. Reporting of sociodemographic determinants also varied considerably between countries, with distinct thematic emphases amongst different countries. Conclusion The observed variation in reported sociodemographic determinants supports development of country-specific equity checklists, enabling more contextually relevant consideration of equity during the development and evaluation of women’s health guidelines.