Gender, Risk, and Mortality in Sub‑Saharan Africa: A Comparative Analysis of Maternal and Male Deaths with Evidence from The Gambia

Abstract

Background: Sub-Saharan Africa carries a disproportionate burden of preventable maternal deaths while also experiencing substantial male mortality across communicable diseases, injuries, violence, non-communicable diseases, and other life-course risks. These burdens are both shaped by sex and gender, but their causal pathways and service-delivery requirements are not interchangeable. Objective: To compare the causal structures, implementation barriers, and strength of evidence informing maternal- and male-mortality policy in sub-Saharan Africa, with a focused interpretation of evidence from The Gambia. Methods: A structured narrative review was updated through July 2026 using PubMed/MEDLINE-indexed literature, publisher records, and authoritative WHO and United Nations sources. Priority was given to systematic reviews, meta-analyses, population-based studies, cohort studies, implementation evaluations, and recent regional burden analyses published from 2015 onward. Evidence was synthesised across burden, access, quality, continuity of care, intervention effectiveness, and mortality endpoints. Results: Maternal mortality policy has a comparatively coherent intervention pathway linking antenatal care, skilled attendance, emergency obstetric care, referral, transport, respectful care, and postpartum follow-up, but losses between these components remain common. Male mortality is more heterogeneous and requires life-course and multisectoral responses. The strongest male-specific intervention evidence remains concentrated in HIV, where men often enter care later and have poorer cascade outcomes. HIV self-testing, differentiated delivery, and integration can improve testing, linkage, retention, and viral suppression, although mortality benefits are not consistently demonstrated. Evidence from The Gambia shows continuing maternal mortality, substantial male involvement in reported road fatalities, marked sex differences in the HIV treatment cascade, and unmet mental-health and sexual-health needs among some groups of men. Conclusions: A gender-responsive mortality agenda should combine shared health-system infrastructure with differentiated pathways. Maternal survival requires reliable emergency and reproductive care, while male survival requires earlier and more acceptable access to prevention, diagnosis, treatment, and multisectoral risk reduction. Evaluation should privilege mortality, effective coverage, quality, equity, and cost rather than service contacts alone.