Factors Influencing Maternal and Neonatal Mortality in South Asia and Southeast Asia (2010-2023): A Comparative Panel Data Analysis

Abstract

Background Maternal and neonatal mortality remains a critical public health challenge in low- and middle-income countries, particularly in South Asia and Southeast Asia. Despite progress, regional disparities persist, and the influence of socioeconomic and health system factors varies across contexts. This study aimed to comparatively assess determinants of maternal mortality ratio (MMR) and neonatal mortality rate (NMR) across these regions. Methods An ecological longitudinal panel study was conducted using data from the World Bank for 19 countries (2010-2023). Outcomes included MMR and NMR, while explanatory variables were health expenditure, gross domestic product (GDP) per capita, adolescent fertility rate (AFR), anaemia prevalence among pregnant women, and a COVID-19 indicator. Log-transformed variables were analysed using fixed and random effects regression models, with Hausman tests guiding model selection. Stratified and interaction analyses assessed regional differences. Results Both regions showed declining mortality trends, though South Asia consistently exhibited higher MMR and NMR. GDP per capita was inversely associated with both outcomes across regions. In South Asia, health expenditure and GDP were protective, while AFR significantly increased both MMR and NMR. In Southeast Asia, anaemia prevalence emerged as the strongest predictor of increased mortality. The COVID-19 period was associated with a significant rise in maternal mortality but not neonatal mortality. Interaction models revealed stronger effects of health expenditure in South Asia. In addition, the association between adolescent fertility and mortality differed by region, being negative in Southeast Asia but positive in South Asia, indicating a reversal in the direction of association across regions. Conclusion Maternal and neonatal mortality outcomes in South Asia and Southeast Asia are associated with region-specific socioeconomic, demographic, and health-system factors. Economic development is protective, whereas adolescent fertility and maternal anaemia are key risk factors. Targeted, context-specific interventions focusing on strengthening health systems, reducing adolescent pregnancies, and addressing maternal anaemia are essential for further mortality reduction.