Adolescent Birth Rates and Female Education Drive Maternal Mortality Disparities in Low- and Middle-Income Countries

Background: Maternal mortality remains disproportionately high in low- and middle-income countries (LMICs), underscoring the urgent need to strengthen Primary Health Care (PHC) systems. This study examines the association between key PHC dimensions—reproductive health services, women's empowerment, and socioeconomic factors—and maternal mortality outcomes across 75 LMICs. Methods: Using a cross-sectional design with Gender Inequality Index (GII) data, we analyzed maternal mortality ratios in relation to adolescent birth rates, female secondary education, parliamentary representation, and labor force participation. Statistical analysis included descriptive statistics, correlation analysis, and comparative visualization across five geographic regions. Results: Maternal mortality was significantly higher in low-income countries (mean = 469.7) compared to middleincome countries (mean = 174.4). Strong correlations were identified between adolescent birth rates and maternal mortality (r = 0.75), and between female secondary education and maternal mortality (r = -0.65). Sub-Saharan Africa demonstrated catastrophic outcomes, with maternal mortality rates 3-10 times higher than other regions. Female parliamentary representation showed weak association with maternal health outcomes. Conclusion: PHC dimensions, particularly adolescent reproductive health services and female education, demonstrate strong associations with maternal mortality. The findings suggest that targeted investments in these PHC components could significantly accelerate progress toward Sustainable Development Goal (SDG) targets, especially in high-burden regions like Sub-Saharan Africa. Comprehensive PHC strengthening should prioritize evidence-based interventions addressing both health service delivery and social determinants of maternal health.