Background and Objective:
The maternal mortality ratio (MMR) is the key indicator that characterizes the state of a healthcare system. Various countries reports indicate a significant impact of the COVID-19 pandemic on MMR. We aimed to determine MMR trends in Central Asia (CA) countries and its association with the total health expenditures before and after pandemic. We also compared the maternal mortality causes before and during the pandemic in Kazakhstan.

Methods:
We conducted a retrospective study working with the secondary data which were collected on selected health indicators using information from open sources, and official statistical data on the Republic of Kazakhstan, Republic of Kyrgyzstan, Republic of Uzbekistan, and Tajikistan. We applied the linear regression analysis to identify statistically significant trends of MMR in CA countries from 2000 to 2020 in the study. Pearson correlation analysis was used to assess the associations between the national MMR and CA total health expenditures expressed in national currency units. R-studio soft version 1.2.5033 was used for the statistical analysis.

Results:
During the pre-pandemic period, Central Asian nations had a downward trend of maternal mortality. Except for Uzbekistan, where this indicator decreased, all Central Asia countries experienced a sharp increase in maternal mortality ratio in 2020. The share of indirect causes of maternal deaths in Kazakhstan reached 76.3% in 2020. There is an association between the maternal mortality ratio in Central Asia countries and their total health expenditures expressed in national currency units (r max= -0.89 and min=-0.66, p < 0.01).

Conclusion:
The COVID-19 pandemic has noticeably impacted the maternal mortality levels in most of the CA countries. The findings suggest that there must be additional efforts from the local authorities to enhance the preparedness of CA healthcare systems for the new public health challenges and improve health data accessibility.