Association between multidimensional poverty intensity and maternal mortality ratio in Madagascar: Analysis of regional disparities

Abstract Introduction Maternal mortality remains a pressing public health concern in Madagascar, with an estimated 408 deaths per 100,000 live births. This study examines whether regional variations in the intensity of multidimensional poverty are associated with the maternal mortality ratio (MMR). Methods We analyzed data from the Third General Population and Housing Census across 22 regions. A cross-sectional approach was used to assess household deprivation and MMRs. Multidimensional poverty was measured using nine indicators across three dimensions – education, health, and living conditions – following the Alkire-Foster method. A simple linear regression model was developed using R version 4.4.2 to test the association between the intensity of multidimensional poverty and MMR. Results A strong positive correlation was observed between the intensity of multidimensional poverty and MMR ( r = 0.642, p < 0.001), explaining 41.2% of the variation. Rural regions exhibited significantly higher multidimensional poverty index (MPI) and MMR values than urban ones. A one-point increase in MPI was associated with an average rise of 24 maternal deaths per 100,000 live births. Conclusion Multidimensional poverty intensity is strongly associated with maternal mortality in Madagascar. These findings underscore the need for targeted policies addressing structural deprivation to improve maternal health outcomes, particularly in high-poverty rural regions.