Maternal mortality and health in the Arab World: A 25-year epidemiological study Hussein H. Khachfe 1 , Julie Sammouri 1 , Hamza A. Salhab 1 , Mohamad Y. Fares 1 and Roula El-Najjar 2 1 Faculty of Medicine, American University of Beirut, Beirut and 2 Department of Obstetrics and Gynecology, Middle East Institute of Health, Bsalim, Lebanon Abstract Aim: In this work, we aim to assess the maternal health in terms of maternal mortality ratios and lifetime risk of maternal death in of women in the Arab World. Methods: Data on maternal mortality rates (MMR) and lifetime risk of maternal death (LTR) were extracted from the official databases of the United Nations Children’s Fund. Annual Percentage Change was calcu- lated using Joinpoint regression model. Statistical significance among countries was determined using one- way analysis of variance (ANOVA) on SPSS version 25.0 (IBM SPSS, 2017). Results: The MMR and LTR significantly decreased in almost all Arab countries. Somalia was found to be the country with the highest burden of MMR, while Gulf countries had the lowest burden. Conclusion: Our study shows a decrease in the MMR and LTR of maternal death in the Arab world. Although there is a decrease in these rates, but continuous research and efforts must be undergone to better develop the health care system in a great number of Arab countries to decrease the burden of maternal deaths. Key words: Arab World, epidemiology, health, maternal, mortality. Introduction Pregnancy and birth related complications are the leading cause of disability and mortality among women of child-bearing age in developing countries, ranking even above cardiovascular disease and cancer related deaths. 1–4 The most common causes of mater- nal mortality are hemorrhage, hypertension, sepsis, abortive outcomes and embolism. 5 Maternal deaths are defined as the death of women while being preg- nant or within 42 days of delivery. The cause of death should be related to the pregnancy itself or its man- agement, but not incidental or accidental according to the World Health Organization (WHO). 6 With that being said, it comes as no surprise that the United Nations signed a declaration in 2000 on eight Millennium Development goals, which included decreasing maternal mortality rates (MMR). 7 Goal 5a called for the reduction of MMR by 75% between 1990 and 2015. 7 Despite global efforts attempting to tack maternal mortality as universal public health concern, still a great number of gaps are present in our detailed knowledge of the levels of maternal mortality and the exact underlying causes of them. The Arab World is a group of 22 countries spread mostly across the Middle East and North African region. 8 Such is the case with other countries and regions worldwide, the Arab world as a whole also has a lack of research on the levels of maternal mor- tality and where it stands concerning the millennium development goals that were set for 2015. Received: June 4 2019. Accepted: August 25 2019. Correspondence: Mr Hussein H. Khachfe, Faculty of Medicine, American University of Beirut Medical Center, 1107 2020, Beirut, Lebanon. Email: hhk15@mail.aub.edu 1 © 2019 Japan Society of Obstetrics and Gynecology doi:10.1111/jog.14119 J. Obstet. Gynaecol. Res. 2019