Childbirth in Africa: World’s Highest Risk Continues

Sub-Saharan Africa, recognized for its rapidly expanding population, tragically accounts for 70% of the global maternal death toll. Annually, the continent witnesses about 180,000 women succumbing to pregnancy-related conditions, accompanied by nearly 1 million newborn fatalities.

The situation is particularly dire in war-torn regions like the Central African Republic, where conflict, displacement, and dwindling aid transform childbirth into a perilous endeavor.

Maude Ahmad Fadala experienced this grim reality after sunset when her labor commenced. Residing in a refugee camp near the Sudanese border and weakened by typhoid, she faced the daunting task of delivering her child without medical facilities or funds for hospital transport. Despite the pain, she walked until she could no longer continue.

“I gave birth in the street,” she recounted. “There was no doctor, no midwife, and no one holding my hand.”

Globally, nearly two-thirds of maternal fatalities occur in nations plagued by conflict or instability, according to a World Health Organization report this year.

For Fadala, who fled Sudan’s conflict only to find herself in the Central African Republic, the threat transcends borders. Displacement often results in missed prenatal care, hazardous journeys, and a collapsing healthcare infrastructure.

According to the United Nations, the maternal mortality rate in the Central African Republic is 40 times higher than in the United States, with 829 women dying per 100,000 births in this impoverished nation. Despite possessing significant gold reserves, basic services remain scarce beyond major cities, with a third of the population subsisting on less than $2 a day.

In 2024, the government unveiled plans to boost resources for skilled birth attendants, yet officials have not clarified the anticipated outcomes of this initiative.

Increase in maternal death risk

The situation is exacerbated by substantial cuts in humanitarian aid by major donor countries, including the U.S., complicating access to care. In Birao, where Fadala now resides, the U.N. Population Fund (UNFPA) faced setbacks when the Trump administration’s funding cuts resulted in job losses for four local midwives.

Across from Fadala’s tent, a now-closed UNFPA-funded “safe space” stands as a reminder of dwindling resources. Previously, it facilitated transport for expectant mothers to the district hospital, serving around 50,000 women. Without U.S. support, all such facilities in Birao, along with two U.S.-funded health centers, have vanished.

“Some women run the risk of dying in pregnancy situations that are not medically managed,” said UNFPA program officer Marie Justine Mamba Ibingui.

UNFPA’s budget in the country has been slashed to $6.5 million over the past two years, according to country director Victor Rakoto. In Birao, the agency was the sole provider of reproductive health supplies. “The risk of maternal death is going to increase if there is no solution,” he warned.

Conflict zones like Birao account for 60% of maternal deaths globally, U.N. data reveals. The district hospital that Fadala attempted to reach lies just a few kilometers away via rugged dirt roads. On a typical day, birthing assistant Delphine Zanabe navigates around waiting patients, with women packed tightly on benches. Many have traveled long distances, enduring bumpy motorbike rides.

“They only come when they are about to give birth,” Zanabe explained. “It’s a struggle and it’s either the baby or the mother who suffers.” WHO recommends at least eight prenatal consultations, but for refugees in impoverished settings, poverty and a lack of education heighten the risks.

In the cramped maternity ward, eight beds accommodate around 70,000 locals and 22,000 Sudanese refugees. Doctors report that aid reductions have led to 12 job losses, mainly in maternity care.

One patient, Amna Adam Hessen, arrived with a malaria-induced fever. Her baby, breech and undetected due to missed check-ups, was lost during a labor marked by heavy bleeding. “Giving birth here is exhausting,” said her mother, Salet, as she comforted Amna on a thin mattress.

Over 40% of births in the country occur outside medical facilities, often leading to preventable deaths, according to the U.N.

‘Abandoned them like that’

Former midwife Clara Abessende, among those who lost jobs in Birao, noted that after Sudan’s conflict erupted in 2023, daily arrivals of women tripled, even as essential supplies dwindled. “There were more cases of infant and maternal deaths,” she lamented, her redundancy weighing heavily on her conscience.

“The children born in my hands … I abandoned them like that,” she reflected.

One expectant mother, Katidje Idrisse Tahire, walks slowly through the camp at nine months pregnant, with a child on her back and two beside her. She fled Sudan months ago, only to be robbed at the border, losing contact with her husband.

“My whole body aches,” she shared. “I am very tired and unwell.”

Lacking funds, she remains uncertain whether medical care will be available when the time comes.