Abstract
National averaged maternal mortality is an indicator of health system resilience but can mask significant territory variation. The aim of this study was to evaluate the national trend of maternal mortality ratio (MMR) in Kazakhstan and estimate the degree of regional disparities in the first year of the pandemic. The annual national series for the official figures were used for the period 2015-2024 and the residence based regional data were used for the years 2019 and 2020. The national series were analysed for percentage changes and period means, while regional distributions were summarised using medians, interquartile ranges, coefficients of variation, the percentile gaps and the rank correlation. National MMR increased from 13.7 per 100,000 live births in 2019 to 36.5 in 2020 and peaked at 44.7 in 2021. The 2020–2021 mean (40.6) was 3.10 times the 2015–2019 mean (13.08), followed by a decline to 10.1 in 2024. Regionally, all 17 units had higher MMR in 2020 compared to 2019. The median increased from 9.3 to 36.8 and the interquartile range increased from 12.9 to 27.8. Kostanay (94.4), North Kazakhstan (76.7), and Aktobe (70.3) had the highest 2020 rates. The correlation between 2019 and 2020 regional ranks was low (Spearman ρ=0.08), suggesting that the shock was not only in regions with higher levels of 2019. The findings justify ongoing subnational monitoring, the yearly review of all maternal deaths, and the need to interpret the annual regional rates with caution, due to the large volatility observed for small numbers of deaths.