10. Mali
> Population: 15.8 million
> GNI per capita: $1,583
> Life expectancy at birth: 58.0 years
> Pct. of pop. with at least some high school: 10.9%

As is the case with so many Sub-Saharan African nations, Mali’s many problems are exacerbated by an extremely high birth rate. Each woman in Mali gives birth nearly seven times on average, compared to just slightly more than two births for every woman in the United States. While this population growth is problematic for a country with limited resources and services, these births are also dangerous to the mothers and infants alike. Mali has one of the highest infant and maternal mortality rates in the world.

9. Mozambique
> Population: 26.5 million
> GNI per capita: $1,123
> Life expectancy at birth: 55.1 years
> Pct. of pop. with at least some high school: 3.6%

Roughly 81% of people in Mozambique work in agriculture, the second highest share of any country in the world. As in many countries with primarily agrarian economies, residents of the Sub-Saharan nation are poor. Mozambique’s 26.5 million residents earn $1,123 per capita each year.

Gender inequality is a major impediment to development in Mozambique. Indicative of the very poor living conditions, the annualized female suicide rate of 21 incidents for every 100,000 people is higher in Mozambique than in every other country except for Guyana. Similarly, while educational attainment is low across the board, the numbers are far worse for women. Only 6.2% of men in the country have received at least some secondary education, while an even worse 1.4% of women have. Additionally, while the literacy rate among men between the ages of 15 and 24 is roughly 80%, the literacy rate among women in the same age group is only 57%. Despite major discrepancies in educational attainment and outcomes, women comprise roughly 40% of the country’s parliament, one of the most equal gender ratios in any national government.

8. Sierra Leone
> Population: 6.2 million
> GNI per capita: $1,780
> Life expectancy at birth: 50.9 years
> Pct. of pop. with at least some high school: 15.7%

Sierra Leone gained a fair amount of international attention during the civil war that ravaged the nation for roughly a decade. While the nation has been in relative peace since 2002, it still struggles with the aftermath of years of brutal warfare. Internal conflicts and tribal skirmishes have resulted in the deaths of hundreds of thousands of Sierra Leonese since 2002. The nation’s economy remains extremely limited, with more than two-thirds of all residents employed in agriculture. Extreme poverty and poor health care have resulted in devastatingly poor health outcomes. The country has the worst infant mortality rate in the world. For every 1,000 live births in the West African nation, more than 100 infants die. Also, more than 160 children die before they reach the age of five out of every 1,000 Sierra Leonean children.

7. Guinea
> Population: 12.0 million
> GNI per capita: $1,096
> Life expectancy at birth: 58.8 years
> Pct. of pop. with at least some high school: N/A

Guinea is one of only 23 countries where life expectancy at birth is less than 60 years. As is the case in many countries on this list, a high child mortality rate contributes to the country’s low life expectancy. Roughly one in 10 children die before they reach their fifth birthday. Poor health is at least partially attributable to a high adolescent birth rate. Each year, roughly 131 children are born to adolescent mothers for women between the ages of 15-19.

The high birth rate is likely a burden on the already strained health institutions in Guinea. Roughly one in four one-year-olds are not immunized for diphtheria, tetanus, or poliomyelitis, the eighth most inadequate immunization rate. For every 10 live births in Guinea, one child dies before age five, also one of the worst such rates worldwide.

6. Burkina Faso
> Population: 17.4 million
> GNI per capita: $1,591
> Life expectancy at birth: 58.7 years
> Pct. of pop. with at least some high school: 2.0%

Roughly 85% of the workforce in Burkina Faso is employed in agriculture, the highest share of any country in the world. As in many countries with an economy based almost entirely on agriculture, residents are poor. Annual income per capita among residents is $1,591, less than half the $3,363 income per capita across the Sub-Saharan African region.

One of the biggest impediments to development in Burkina Faso is a lack of education. Citizens of the African nation receive an average 1.4 years of schooling, the lowest amount of any country reviewed. One consequence of inadequate education is a low literacy rate as nearly three-quarters of adults in the country are illiterate. However, the situation may improve in Burkina Faso as the younger generation enters adulthood. Of those aged 15-24, 47% of males and 33% of females are literate.