Pressure on African women to bear male children is contributing to high maternal risks across the continent, health experts and local accounts indicate. Africa, which accounts for approximately 70 percent of maternal deaths worldwide, also has the highest fertility rates globally, a situation partly driven by cultural preferences favoring sons over daughters.

In many communities, women face blame and social pressure when they give birth to girls, often leading to repeated pregnancies in pursuit of a male heir. Patrick Djem, a reproductive physician based in the Democratic Republic of the Congo (DRC), noted that it is predominantly women who bear the burden of this expectation. "Mostly it is the woman who is blamed for giving birth to a girl," he said, highlighting the gendered nature of reproductive pressure.

Accounts from healthcare workers and residents in Kinshasa illustrate the human cost of these societal norms. Annie Tshiamala, a midwife in the DRC, recounted the case of a woman in her forties who had endured a difficult ninth labor. The woman, who already had eight daughters, was critically exhausted and bleeding heavily. At the moment of birth, her primary concern was the sex of the baby, a reflection of the prevailing cultural desperation for sons.

Gloria Masanka, a Kinshasa-based radio presenter and mother of two daughters, also shared the personal impact of societal pressures. Despite experiencing two miscarriages and facing dangerously elevated blood pressure during pregnancy, she expressed a belief that her marriage would be more stable if she had a son. Her experience underscores the ongoing emotional and physical toll that gender preference can impose on women.

The preference for male children is deeply ingrained in many African societies, often linked to traditions related to inheritance, family lineage, and economic security. While precise data linking son preference directly to maternal mortality is limited, experts argue that the resulting cycles of repeat pregnancies and unsafe childbirth practices contribute to the persistently high maternal death rates seen in the region.

Efforts to address maternal mortality in Africa increasingly recognize the need to confront cultural attitudes toward gender and fertility. Reducing stigma against women who give birth to daughters and promoting gender equality are seen as essential steps in alleviating the health risks women face and in improving overall maternal outcomes.