Maternal mortality ratios in Southeast Asia (1990–2021): trends, disparities, and projections through 2050 based on the global burden of disease 2021, with reference to SDG 3.1

Abstract Background​ Maternal mortality remains a critical barrier to achieving Sustainable Development Goal (SDG) 3.1 (target: Maternal mortality ratios (MMR) < 70 per 100,000 live births by 2030). Southeast Asia accounts for ~ 20% of global maternal deaths, with substantial disparities between and within countries. This study analyzed trends (1990–2021) and projected (to 2050) MMR in Southeast Asia using the Global Burden of Disease (GBD) 2021 database, addressing gaps in regional granularity.​​ Methods​ Data GBD 2021, covering MMR and age-standardized MMR (ASMR) for 1990–2021, stratified by country, age group, and cause.​ Analysis: Trend assessment was conducted using the estimated annual percentage change (EAPC), while 30-year projections were generated via an autoregressive integrated moving average (ARIMA) model. Results Regional Trends: The ASMR in Southeast Asia fell by 59%, dropping from 255.88 in 1990 to 104.56 per 100,000 live births by 2021. This decline was primarily driven by reduced rates of maternal haemorrhage and hypertensive disorders. Progress slowed during the 1997 Asian financial crisis yet picked up pace after 2000. Country Disparities High-burden countries (e.g., Timor-Leste, Laos) achieved notable reductions but still remain far from the SDG 3.1 target; progress halted after 2015.​ Low-burden countries (e.g., Thailand, Mauritius) exhibit an increasing ASMR attributed to "other direct maternal disorders" and indirect causes (e.g., chronic diseases).​ Age-Specific Risks: The highest MMR was observed among women aged 10–14 and those aged 50–54. Ectopic pregnancy and HIV-related maternal deaths are on the rise in specific age cohorts (e.g., 40–54 years). Visual Summary A schematic timeline depicts the regional decline in ASMR (1990–2021), with inset maps illustrating country disparities; age-risk curves highlight peaks in the 10–14 and 50–54-year age groups; projection graphs emphasize the increasing risks in older cohorts. Interpretation Southeast Asia has achieved a 59% reduction in maternal mortality since 1990, yet progress stalled after 2015 as indirect causes, late maternal deaths and HIV-aggravated complications have increased among women aged ≥ 45 years while overall rates continue to fall. Policies must therefore move beyond acute intrapartum care to include age-specific management of multi-system disorders across the perinatal continuum.