From Debt to Delivery: Investigating the Relationship Between Debt Relief and Maternal Health in Sub-Saharan Africa.

Abstract

Despite global improvements in maternal health, Sub-Saharan Africa remains a critical concern, accounting for over two-thirds of the world’s annual maternal deaths. Meanwhile, large external debt stocks, which have long burdened the region, require debt-servicing that is effectively crowding out government health expenditure. For instance, between 2019 and 2021, nearly half of all Sub-Saharan African countries spent more on servicing debt than on healthcare. At the turn of the millennium, the international community implemented two debt relief initiatives – the Highly Indebted Poor Countries (HIPC) initiative, followed by the Multilateral Debt Relief Initiative (MDRI) – to alleviate these countries’ debt burdens and enhance development. Using a sample of 47 Sub-Saharan African countries between 2000 and 2019, this paper empirically investigates the relationship between debt relief under these initiatives and maternal mortality and morbidity. The paper further examines the relationship between debt relief under the initiatives and government health expenditure. Utilizing the variation in initiative participation across time and countries, and employing various econometric specifications, the results indicate that joining the HIPC initiative is associated with statistically significant reductions in the maternal mortality ratio and the lifetime risk of maternal death, as well as a statistically significant increase in government health expenditure as a share of GDP. No conclusive relationships between the MDRI or the amount of debt relief and these outcomes are however found. Furthermore, no conclusive relationships between either the HIPC initiative, the MDRI or the amount of debt relief and maternal morbidity can be established. Considering the increasing debt levels and changing debt structures of Sub-Saharan Africa, along with their potential health development implications, further research on debt relief as a development assistance tool is necessary.