Ecological analysis of gender inequality and maternal mortality in Eastern Africa across female education, adolescent fertility, political representation, and labour force participation

Maternal health remains a critical challenge in Eastern Africa, where gender inequality and weak health systems contribute to high maternal mortality. Understanding relationships between gender disparities, education, political participation, and maternal mortality is essential for designing effective interventions. This comparative study analyzed 18 Eastern African countries using Gender Inequality Index (GII) components: maternal mortality ratio (MMR), adolescent birth rate (ABR), women’s parliamentary representation, secondary education attainment, and labour force participation. Descriptive statistics, correlation, regression, cluster, and quartile-based gradient analyses were performed using 2022 Human Development Report data (α = 0.05). GII values ranged from 0.369 (Mauritius) to 0.674 (Somalia) (mean = 0.509). MMR varied from 3 (Seychelles) to 1223 (South Sudan). GII correlated positively with MMR (r = 0.684, p = 0.007) and ABR (r = 0.627, p = 0.016); however, because MMR and ABR are GII components, this correlation is partly mechanical. Female secondary education (FSE) correlated negatively with MMR (r = − 0.713, p = 0.006), while adolescent birth rate (ABR) correlated positively (r = 0.681, p = 0.002). Regression identified FSE (β = − 0.512, p = 0.021) and ABR (β = 0.445, p = 0.038) as significant correlates, explaining 67.3% of the variance. Cluster analysis revealed four groups: High-performing (n = 2), Moderate Progress (n = 4), Moderate Challenge (n = 5), and High Challenge (n = 6). Countries with ABR above the regional median (Uganda, Tanzania, Zambia, Malawi, Mozambique, Somalia, Madagascar, Zimbabwe) had mean MMR 267 higher than those below ( p = 0.007). The MMR difference between the lowest and moderate FSE groups was 186 deaths per 100,000, but not statistically significant ( p = 0.08). Parliamentary representation and labour force participation were not significant correlates in regression models. Gender inequality, particularly through female education and adolescent fertility, is strongly associated with maternal mortality in Eastern Africa. Given the ecological, cross-sectional design, these findings are exploratory and should be interpreted with caution. Strengthening primary health care while advancing girls’ education and women’s empowerment offers a promising pathway toward SDG 3.1 targets.