Explainable Ensemble Learning for Maternal Health Risk in Low-Resource Settings

Maternal health remains a global challenge, particularly in low-resource settings where accurate and timely risk prediction is essential to reducing maternal mortality. This study proposes an explainable machine learning framework for predicting maternal health risks by integrating ensemble learning methods with SHAP (Shapley Additive exPlanations) for interpretability. This study utilized the publicly available Maternal Health Risk Data Set (MHRDS), comprising physiological features such as systolic and diastolic blood pressure, blood sugar level, body temperature, and age. A total of 18 machine learning models including Random Forest, XGBoost, LightGBM, Neural Networks, and TabNet were evaluated to compare individual classifiers and ensemble approaches comprehensively. The selection of this diverse set of models is grounded in the need to benchmark different algorithmic paradigms, as variations in inductive bias, learning capacity, and robustness to clinical data noise can influence predictive performance and generalizability. This comprehensive comparison enables the identification of optimal model types for integration into ensemble frameworks. Evaluation was performed across three different test scenarios (test sizes of 10%, 20%, and 30%) to assess model consistency under varying data partitions. Stacking, Voting, and Histogram-based Gradient Boosting showed consistently high performance, with Stacking achieving the highest accuracy of 87.2%, followed by Histogram Gradient Boosting (86.9%) and Voting (86.7%) at test size 0.2. SHAP analysis identified blood sugar, systolic blood pressure, and maternal age as the top predictors across all test scenarios. The best-performing models were deployed into a web-based clinical decision support system designed for healthcare practitioners in Indonesia. The proposed approach balances predictive accuracy and model transparency, offering a practical solution for improving maternal care in data-limited environments.