Background <p>Preventable complications related to early adolescent childbearing continue to be a major contributor to maternal mortality in Sub-Saharan Africa, necessitating targeted interventions. Despite the high burden of early adolescent childbearing in Sub-Saharan Africa, there is limited pooled evidence on its prevalence and determinants in high maternal mortality regions, necessitating this study. Thus, this study aimed to assess the prevalence and determinants of early adolescent childbearing in extremely high and very high maternal mortality rates in SSA countries.</p> Methods <p>This study used nationally representative demographic health survey data from 2013 to 2022 from adolescent women in extremely high and very high SSA countries. A total of 31, 512 weighted samples adolescents (15 to 19 years) of women were included. The Stata version 14 statistical package was used. Multilevel logistic regression was employed to assess individual and community-level factors associated with early adolescent childbearing, adjusting for clustering effects within DHS data, at p values &lt; 0.05 with adjusted odd ratios at 95% confidence intervals (CIs).</p> Results <p>The overall prevalence of early adolescent childbearing in extremely high and very high maternal mortality SSA countries was 20.74% (95% CI: 20.3%, 21.2%). Chad had the highest prevalence (31.67%), while Kenya had the lowest (13.7%). Residence (AOR = 1.3, 95% CI: 1.19, 1.45), education: no formal education (AOR = 3.5, 95% CI: 3.09, 3.87), primary education (AOR = 2.3, 95%CI:2.11, 2.55), adolescent age group of 18–19(AOR = 4.9, 95% CI:4.6, 5.33), religion: Islam followers (AOR = 1.3, 95% CI:1.13, 1.48), no religion (AOR = 2.0, 95% CI:1.51, 2.71), household wealth: poor (AOR = 1.8, 95% CI: 1.59, 1.96), middle (AOR = 1.5, 95% CI: 1.32, 1.64), household size:1 to 3 (AOR = 3.5, 95% CI: 3.22, 3.84), 4 to 5 (AOR = 1.3, 95% CI:1.19, 1.42), never had media exposure (AOR = 1.2, 95% CI: 1.06, 1.28), had own mobile (AOR = 1.5, 95% CI: 1.34,1.64), never used internet (AOR = 1.6, 95% CI: 1.43, 1.89), male household head (AOR = 1.62, 95% CI: 1.49, 1.77), undecided fertility preference (AOR = 2.5, 95% CI: 2.17, 2.92), contraception: ever used methods (AOR = 1.9, 95% CI:1.7, 2.18), nonuser intend to use later (AOR=,1.4 95% CI: 1.32, 1.56), countries: Liberia (AOR = 1.6, 95% CI:1.3, 1.99) and Chad (AOR = 2.2, 95% CI: 1.82, 2.59) were positively associated with early adolescent childbearing whereas not having work (AOR = 0.9, 95% CI: 0.85, 0.99), not visited by community health worker (AOR = 0.8, 95% CI: 0.69, 0.89), ever visited health facility for reproductive health service (AOR = 0.2, 95% CI: 0.19, 0.22), had knowledge about contraceptive (AOR = 0.5, 95% CI:0.48, 0.60) and countries: Kenya (AOR = 0.54, 95% CI: 0.45, 0.65), Lesotho (AOR = 0.73, 95% CI:0.58, 0.95) and Nigeria (AOR = 0.72, 95% CI:0.62, 0.85) were factors negatively associated with early adolescent childbearing.</p> Conclusion <p>This study showed that the prevalence of early adolescent childbearing in extremely high and very high maternal mortality SSA countries remains high. Level of education, age, religion, residence, household wealth, household size, media exposure, own mobile, internet use, fertility preference, contraception use and intention, working status, visited by community health worker, knowledge of contraceptive, visited health facility for reproductive health service and countries were associated with early adolescent childbearing. Hence, these findings underscore the need for policies that enhance education access, reproductive health services, and economic opportunities to mitigate early adolescent childbearing.</p>