Maternal Mortality in Nepal: Identifying High-Risk Groups Through Census Data.

Nearly all maternal deaths are preventable, yet Nepal's maternal mortality ratio remains high, with social and geographic disparities. Beyond direct obstetric causes, factors such as education, income, and place of residence influence maternal mortality risk, but disaggregated national data remain limited. This study examined the social determinants and timing of maternal deaths in Nepal to identify high-risk groups and inform targeted interventions. A cross-sectional descriptive study was conducted using microdata from the 2021 National Population and Housing Census, applying a stratified, probability-based sampling design to ensure national representativeness. Deaths among women aged 15-49 were identified through household reports. Data were collected on sociodemographic characteristics, household wealth, ethnicity, and place of residence. Deaths were classified by cause, and maternal deaths were further classified by timing, including during pregnancy, childbirth, or within six weeks postpartum. Descriptive statistics were calculated using sampling weights. Of 1,386 deaths among women aged 15 to 49 years, 54 (3.9%) were maternal deaths, with 74.6% occurring within six weeks postpartum. Non-communicable diseases were the leading cause of death overall (49.9%). Maternal deaths were most frequent in Lumbini province, peri-urban and rural areas, and the Tarai region. Socioeconomic disparities were evident, with nearly half of maternal deaths occurring among women from poor households. Most women who died from maternal causes were aged 20-34 years. Maternal mortality in Nepal reflects social and geographic inequalities, with higher risk among poorer women, those in rural and peri-urban areas, and specific provinces, particularly during the postpartum period. Strengthening antenatal care, skilled birth attendance, and equitable, context-specific interventions is essential to reduce preventable maternal deaths.