Regional Convergence and Temporal Volatility in Maternal Mortality: An Ecological Time-Series Analysis from Türkiye, 2008–2023

Abstract Background Maternal mortality has declined in Türkiye over the past three decades, yet regional disparities are persistent. Understanding temporal and spatial variation is essential for assessing progress toward Sustainable Development Goal 3.1 and for guiding sub-national interventions. Methods This ecological time-series study analysed regional maternal mortality ratios (MMR, per 100,000 live births) across twelve NUTS-1 regions of Türkiye between 2008 and 2023, using data from the Ministry of Health and Turkish Statistical Institute. Linear regression was used to estimate annual slopes and average percent change (APC) for each region. Inter-regional inequality was assessed annually with the Gini coefficient and coefficient of variation (CV). Within-region volatility, peak–trough ranges, and largest single-year changes were also examined to capture temporal instability. Results National MMR declined consistently from 2008 to 2023, indicating broad progress. The Gini and CV both showed a downward trend, demonstrating increasing equitable access to maternal healthcare, although inequality temporarily widened around 2022. Eastern and Southeastern Anatolia and the Western Black Sea showed the steepest declines, while Western Marmara and Central Anatolia displayed marked inter-annual oscillations. Several regions experienced sharp one-year reversals, possibly related to system shocks such as the COVID-19 pandemic or unexpected migration. Conclusions Türkiye achieved substantial reductions in maternal mortality while simultaneously narrowing regional gaps, yet volatility persists. Tracking both the level and stability of MMR, through inequality and variability metrics, offers a more complete picture of system performance and resilience. Strengthening sub-national surveillance and maintaining service stability remain critical for achieving equitable maternal health outcomes.