Trends in Maternal Mortality Rates in Tunisia, 2019-2023

Abstract Background Despite extensive global efforts to address maternal mortality as a public health concern, several gaps persist in developing countries. In Tunisia, significant progress has been made over the last decades to align with the Sustainable Development Goals (SDG). We aimed to examine recent trends in Maternal Mortality Rates (MMR) in Tunisia. Methods Data from the national Maternal and Child Health Program, for the period 2019-2023 were used. The MMR was calculated by dividing the number of maternal deaths per 100 000 live births (WHO definition). The annual number of live births was obtained from the national institute of statistics. Join-point trend analysis software (version 4.7.0) was used to compute Annual Percentage Change (APC), and a p-value less than 5% was considered to conclude to test significance. Results A total of 205 maternal deaths were reported, with a mean age of 33.5±0.4 years. The MMR increased from 22.9 to 34.3 /100 000 live births between 2019 and 2021, then to 34.7/100 000 live births in 2023. The trend was stable over the study period with no significant differences in MMRs (APC equal to 2.9). The SDG (MMR less than 70/100.000) has been exceeded in the governorates of Gabes and Tozeur (two governorates located in the southern region of Tunisia) with MMRs of 73.5/100.000 and 73.2/100.000 live births, respectively. Conclusions Our study suggested the impact of social determinants of health on MMRs in Tunisia. Therefore, an effective implementation of the mother and child strategy is strongly recommended to reduce regional disparities. Furthermore, cross-checking data with those derived from the national information system on causes of death is crucial to improve mortality data completeness and reliability in Tunisia. Key messages • Over the study period, the MMR in Tunisia was below the threshold set as part of the SDGs (70/100 000 live births), except for two governorates with relatively limited access to specialized healthcare. • Data cross-checking between the national Maternal and Child Health Program and the national Information System on Causes of Death is crucial to improve data reliability and completeness.