Exploring the spatial nexus between air quality, climate change, and socioeconomic determinants of maternal mortality across the Asia–Pacific region

Despite progress in reducing maternal mortality, it remains a major public health concern in the Asia–Pacific region, where environmental degradation, climate change, and socioeconomic inequalities continue to affect maternal health. This work aims to analyze the influence of these environmental factors, such as air pollution, climate, renewable energy, and socioeconomic conditions, on maternal deaths in a country, and includes the spatial dependence between countries. The analysis is based on panel data for 42 countries in the Asia–Pacific for the period 2005–2024 and is estimated using a Dynamic Spatial Durbin Model (DSDM) with Quasi-Maximum Likelihood (QML) estimation. The spatial interactions are computed using Inverse Distance Weighting (IDW) and K-Nearest Neighbors (KNN-6) spatial weight matrices. The results show a high level of positive spatial dependence in maternal mortality, suggesting that maternal health in one country is related to that in neighbouring countries. Air pollution has a positive and statistically significant effect on maternal death; greenhouse gas emissions exacerbate the risk to maternal health. The effect of temperature is positive, with the IDW specification indicating that warmer temperatures are associated with greater maternal mortality, with the magnitude depending on the alternative spatial weighting schemes. In contrast, maternal mortality is significantly lower with higher population density and GDP per capita, which can be attributed to better access to health services and infrastructure, and better economic development. Renewable energy use shows a strong and significant mitigative effect, indicating its potential contribution in reducing the health impacts arising from environmental factors. There is a positive association between healthcare spending and maternal mortality, but the results are model-specific. The DSDM framework is supported by diagnostic tests, which show evidence of spatial dependence. The results highlight the need for incorporating environmental sustainability, climate adaptation, and regional cooperation in maternal health strategies. Enhanced transitions toward renewable energy, decreased air pollution and emissions of GHGs, and more coordinated cross-border health and environmental policies can significantly help to reduce maternal mortality in the Asia–Pacific region.