Maternal Mortality Trends in Saudi Arabia: A Review

Maternal mortality represents a critical indicator of national health system performance and socio-economic development. Despite progress in obstetric care worldwide, maternal mortality remains unequally distributed between high-income and low and middle-income countries. Saudi Arabia has made significant progress in reducing maternal deaths over recent decades; however, persistent clinical, systemic, and socio-cultural challenges continue to influence maternal outcomes. This review provides an updated maternal mortality trends in Saudi Arabia from July 2020 to December 2023. Literature was identified through structured searches of PubMed, Scopus, and WHO/UNICEF repositories using terms such as “maternal mortality, “Saudi Arabia,” “pregnancy complications,” and “obstetric causes of death”. For this narrative review, themes were synthesised qualitatively, and findings were compared across regions, populations (Saudi vs. expatriates), and facility types (primary vs. tertiary care). The findings demonstrate that Saudi Arabia maintains a low maternal mortality ratio (MMR) compared with global averages, with estimates ranging between 7 and 17 deaths per 100,000 live births during the review period. Nonetheless, variations persist between regions due to disparities in access to specialised care, emergency obstetric services, and referral efficiency. Direct obstetric causes such as postpartum haemorrhage and hypertensive disorders remain predominant, while indirect causes such as cardiac disease, obesity, diabetes, and viral infections have increased in relative significance. Additional determinants include late presentation, limited awareness of warning signs, socio-economic inequities, and cultural factors influencing health-seeking behaviour. The review concludes that strengthening maternal services requires expanded midwifery capacity, improved emergency obstetric response systems, standardised national guidelines, and enhanced data reporting mechanisms. Targeted public-health interventions addressing obesity, diabetes, and high-risk pregnancies are crucial. This review provides insightful recommendations for clinicians, policymakers, and researchers aiming to support Saudi Arabia’s continued progress toward the Sustainable Development Goals.