Inequality and Maternal Survival in Sub-Saharan Africa: A Comparative Cluster Analysis of 49 Countries

Background: Sub-Saharan Africa bears the highest burden of gender inequality and maternal mortality globally. Female secondary education is widely recognized as a critical determinant of both, yet comprehensive comparative evidence linking these factors across the region remains limited. Objective: This study provides a multi-dimensional comparative analysis of gender inequality and maternal survival across 49 sub-Saharan African countries using the 2023 Gender Inequality Index (GII). It employs cluster analysis to identify distinct country profiles and inform differentiated policy responses. Methods: Data were extracted from the United Nations Development Programme (UNDP) 2023/2024 Human Development Report, covering 40–49 countries depending on indicator completeness. Descriptive statistics, Pearson correlations, multiple linear regression, and k-means clustering were performed. Comparative analysis by human development strata and regional benchmarks was conducted. Results: Wide inter-country heterogeneity exists: GII values range from 0.325 (Cabo Verde) to 0.677 (Nigeria); maternal mortality ratios from 3.3 (Seychelles) to 1,223 (South Sudan) per 100,000 live births. Significant negative correlations were found between female secondary education and both GII (r = –0.67) and maternal mortality (r = –0.51). Regression analysis revealed that female secondary education (β = –0.51, p < 0.001) and adolescent birth rate (β = 0.37, p < 0.01) are the strongest predictors of gender inequality. Cluster analysis identified three distinct country profiles: "High inequality – high mortality" (n = 17), "Moderate performers" (n = 15), and "Lower inequality – better health" (n = 8). Substantial gender gaps persist in secondary education (average female–male difference = –9.8 percentage points) and labour force participation (–17.4 percentage points). Conclusion: Strengthening girls' secondary education and reducing adolescent childbearing are pivotal levers for reducing gender inequality and improving maternal survival in Sub-Saharan Africa. Policy efforts must be tailored to cluster-specific challenges, with priority investments in the Sahel and conflict-affected states.