Magnitude and Patterns of Maternal Mortality in Montserrado County, Liberia, September 2021–September 2025

Background: Maternal death is the most dangerous pregnancy complication outcome globally. Montserrado accounted for a high proportion of deaths. The burden remains high despite continued support from the Government of Liberia and other developmental partners under Sustainable Development Goal (SDG) 3.1 to reduce maternal Mortality.  Objective: The study aimed to describe the temporal trends, magnitude, and spatial distribution of maternal health outcomes within the seven districts in Montserrado between September 2021 and September 2025 Methodology: The study was conducted in Montserrado County, which has an estimated population of 1.92 million, according to the 2022 census report. A descriptive, retrospective cross-sectional design was used. The designs used in this study were appropriate given the availability of existing data. The data were approved by the Ministry of Health (Montserrado County Health Team) through the Maternal Deaths Surveillance and Response and the Integrated Disease Surveillance and Response. The District Health Information Software version 2 was used to calculate the Maternal Mortality Ratio. Findings 470 maternal deaths were reported in Montserrado from September 2021 to September 2025. The proportion of deaths ranged from 469.8 to 329.7 maternal deaths per 100,000 live births. The highest MMR was in 2024 (469.8 deaths) and the lowest in 2025 (329.7 per 100,000 live births). The distribution of maternal deaths varied across the seven health districts. The highest proportion of deaths was recorded in Central Monrovia (54.68%, n=257), followed by Bushrod (27.23%, n=128) and Commonwealth (8.09%, n=38). The lowest proportion of deaths was recorded in St. Paul (0.64%, n=3). Conclusion: Maternal Mortality continued to be a public health concern in Montserrado County, with deaths exclusively concentrated in two reporting health districts. Despite the downward trend in the Maternal Mortality Ratio at the end of the study period, the burden remains high. These findings show the need for strengthening maternal health services, improving maternal death surveillance, and focusing on interventions within high-burden districts to reduce maternal Mortality and support progress toward achieving the SDG 3.1 targets.