Social Determinants and Inequality in Maternal and Child Health in Sub-Saharan Africa: A Critical Review and Analytical Synthesis

Sub-Saharan Africa (SSA) continues to bear a disproportionate burden of maternal and child mortality despite two decades of global health investment, accounting for approximately 70% of global maternal deaths and some of the highest under-five mortality rates worldwide. These outcomes are not reducible to biomedical or health-system failures alone; they reflect deeply rooted social determinants embedded within historical, political, and economic structures. This paper provides a comprehensive theoretical and empirical synthesis of the social determinants driving maternal and child health (MCH) inequalities in SSA, integrating the WHO Commission on Social Determinants of Health framework, the Mosley–Chen child survival model, and an intersectionality lens. A systematic narrative review of peer-reviewed literature, Demographic and Health Survey analyses, and multilateral organisation reports was conducted. Studies spanning wealth inequality, educational disadvantage, rural–urban spatial disparities, gender inequality, health system quality, temporal trends, and intersectional multiple disadvantages were critically synthesised. Persistent pro-rich inequalities in skilled birth attendance, antenatal care uptake, and child immunisation were identified across the region. Maternal education emerged as an independent protective factor for child survival. Rural populations face compounded barriers including geographic isolation, health workforce shortages, and weak emergency referral systems. Gender inequality and restricted female autonomy remain structural drivers of poor reproductive health outcomes. Healthcare quality deficits, not merely access gaps, contribute substantially to preventable mortality. The inverse equity hypothesis is supported: health improvements disproportionately benefit wealthier, urban populations first. MCH inequalities in SSA arise from the interaction of poverty, educational disadvantage, gender inequality, geographic isolation, and weak health systems. An intersectional approach reveals that compounded disadvantages produce multiplicative not merely additive harm. Achieving equitable MCH outcomes requires integrated policies addressing structural determinants alongside health system strengthening.

maternal health; child health; social determinants; Sub-Saharan Africa

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