The stakes could hardly be higher. Maternal mortality is defined as the annual number of female deaths from any cause related to or aggravated by pregnancy or its management, excluding accidental causes, during pregnancy and childbirth or within 42 days of termination of pregnancy. Of the roughly ten categories of hundreds of thousands of women who die each year during pregnancy or childbirth, two out of three live in Africa. A woman on the continent faces a lifetime risk of dying from a high-risk pregnancy of about 1 in 41, compared with roughly 1 in 11,000 in high-income countries. The ten countries with the highest maternal mortality ratios are all African. According to United Nations Maternal Mortality Estimation Interagency figures cited in the study, maternal deaths in Africa fell from 727 per 100,000 live births in 2000 to 442 in 2023—a near-halving—yet the continent remains far off track for the Sustainable Development Goal target of fewer than 70 deaths per 100,000 live births by 2030. In 2023, Nigeria recorded 993 deaths per 100,000 live births, Chad 748, and South Sudan and the Central African Republic 692 each.

The economic backdrop to these numbers is bleak. The study documents a disturbing resurgence of acute lived poverty across the continent, reversing hard-won gains of the previous two decades. Acute lived poverty manifests as widespread deprivation of cash income, inadequate access to medicines and insufficient food—a constant denial of life’s basic necessities. Nearly 464 million Africans lived in severe poverty in 2024, and roughly 440 million survived below the global extreme poverty line of US$2.15 per person per day, limiting access to education, healthcare, and infrastructure, particularly in rural and socially excluded communities. The World Bank put the figure at more than 476 million people in abject poverty in 2024, up from 490 million in 2021, split into 241 million males and 249 million females. At current rates, only 2.6 people escape poverty per minute on the continent. The researchers identify high debt distress risks, limited investment in income-generating sectors, lingering inflation, cuts in donor aid, weak governance, corruption, and inefficient institutions as the drivers. In countries spending more on debt interest than on health infrastructure, they argue, pregnant women bear the greatest burden.

The geography of deprivation maps directly onto the geography of maternal death. The study notes that maternal mortality ratios are dramatically higher in institutionally fragile countries than in stable ones, a pattern tied to what researchers call fragile settings—nations afflicted by severe instability, collapsed infrastructure, or food insecurity, where health systems simply cannot function. When clinics close and supply chains for essential medicines disappear, women lose their only line of protection during delivery. East and West Africa account for about 73 percent of the continent’s poor, while Southern and North Africa have the fewest people in poverty. The campaign slogan that has electrified African political leaders—Africa cares: no woman should die while giving life—has propelled governments to treat high maternal mortality as a policy failure rather than an unfortunate and expensive occurrence. The evolution from the Campaign on Accelerated Reduction of Maternal Mortality in Africa to CARMMA Plus in 2021 marks, in the authors’ view, a shift from naming the problem to building structures to solve it.

Methodologically, the research breaks new ground by moving beyond the single-variable, country-specific studies that have dominated the literature. Anchored in Amartya Sen’s Capability Approach, which holds that income and wealth are means toward human development rather than ends in themselves, the study models maternal mortality as a function of female employment, female education, the logarithm of gross domestic product per capita, domestic general government health expenditure, and government effectiveness. The authors justify female employment and education as proxies for poverty reduction because they generate income, empowerment, and access to resources, while GDP per capita serves as a standardized gauge of economic output per person. Data came from the World Development Indicators, the World Health Organization, and the World Bank, covering Burkina Faso, Tunisia, Nigeria’s peers such as Chad and the Central African Republic, and 32 other nations where data were available.

The econometric machinery behind the findings is sophisticated. The team employed Dynamic Fixed Effect estimation and Panel Autoregressive Distributed Lag models, comprising Mean Group and Pooled Mean Group techniques, chosen over Generalized Method of Moments for their simplicity, efficiency, and ability to handle endogeneity and autocorrelation. Im, Pesaran, and Shin unit root tests confirmed a mixture of stationarity orders among the variables, and the Westerlund panel cointegration test produced a statistically significant statistic of 3.892 with a p-value of 0.000, establishing a long-run equilibrium relationship among the variables at the 1 percent significance level. Descriptive statistics revealed stark heterogeneity: the average maternal mortality rate across the panel was 436 deaths per 100,000 live births, ranging from a low of 17 to a devastating high of 1,650, while average female employment stood at 43.3 percent, female primary completion at 49.5 percent, and government effectiveness averaged −0.59 on a scale from −2.5 to 2.5.

The long-run results are the study’s core contribution. Under the Pooled Mean Group estimator, female employment showed a negative and statistically significant relationship with maternal mortality, with a 1 percent increase reducing the mortality rate by roughly 0.98 percent. Female education was likewise negative and significant at the 5 percent level, decreasing mortality by 0.06 percent, reflecting the power of education to spur awareness and help women navigate healthcare services. Log GDP per capita proved the most ambiguous variable: under Dynamic Fixed Effects, a 1 percent increase cut maternal mortality by 1.3 percent, but under Pooled Mean Group it slightly increased mortality by 0.3 percent, a contradiction the authors attribute to whether national wealth is fairly distributed and to bottlenecks such as delayed access to health facilities and shortages of physicians. Domestic general government health expenditure reduced mortality by 0.0207 percent per unit increase, and government effectiveness by 0.0598 percent per unit—both significant, suggesting that well-monitored health budgets and proactive institutions genuinely save lives at scale.

The short-run picture, however, complicates the narrative in ways that matter for policymakers. In the short run, female employment and female education showed positive and significant relationships with maternal mortality under the Mean Group and Pooled Mean Group estimators. The authors offer several explanations: early employment income may fall short of expectations, leaving little to invest in maternal health; work-related stress among pregnant women who lack sufficient rest may trigger complications; and educated women unable to find gainful employment may lack the money to access care during pregnancy and childbirth. GDP per capita was likewise positive and significant in the short run under Mean Group, possibly because additional income accompanied more pregnancies than households could adequately nourish or treat. Health spending, meanwhile, was positive but insignificant in the short run—money alone, the study warns, is insufficient when corruption diverts resources or when skilled birth attendants, emergency obstetric care, functioning referral systems, and motivated health workers are missing.

The study’s recommendations converge on a single message: the poverty reduction agenda is the maternal health agenda. African governments, the authors argue, should prioritize female employment, expand women’s access to education, pursue well-distributed growth in per capita income that reaches women in particular, increase and carefully monitor domestic health expenditure free of embezzlement, and strengthen the effectiveness of the institutions charged with delivering care. They acknowledge the limitations of their design—the analysis covers 35 of Africa’s 54 countries over a 24-year window, uses only three poverty proxies, draws on a single theoretical framework, and excludes other continents—and they call on future researchers to expand the country sample, lengthen the timeframe, add variables, and apply alternative estimators such as System GMM. Yet the central conclusion stands firm: with maternal deaths halved since 2000 but the continent still accounting for seven of every ten maternal deaths worldwide, the evidence shows that lifting women out of poverty—through work, education, and equitable growth backed by accountable institutions—is among the most reliable paths to making Sustainable Development Goal 5 a reality before 2030. As the authors put it, with joint efforts Africa can raise all boats of prosperity for women, and now is the right time to act.

Subject of Research: The relationship between poverty reduction strategies and maternal mortality rates across African countries

Article Title: Poverty reduction and maternal mortality in African countries

Article References: Adegbola, O., Ebenezer, O. A., & Benedict, O. D. (2026). Poverty reduction and maternal mortality in African countries. Discover Global Society, 4(1), Article 251. https://doi.org/10.1007/s44282-026-00406-6

Image Credits: AI Generated

DOI: 10.1007/s44282-026-00406-6

Keywords: maternal mortality, poverty reduction, Africa, female employment, female education, GDP per capita, health expenditure, government effectiveness, Sustainable Development Goals, panel econometrics, Pooled Mean Group, public health