Africa has some of the world’s highest birth rates, yet giving birth remains exceptionally dangerous for many women on the continent. Sub-Saharan Africa accounts for about 70% of maternal deaths worldwide, with roughly 180,000 women dying each year from pregnancy- and childbirth-related causes. The region also records around 1 million newborn deaths annually.
Conflict makes the situation even worse. The World Health Organization said this year that nearly two-thirds of maternal deaths worldwide occur in countries affected by conflict or fragility. For women forced to flee their homes, displacement can mean missed prenatal appointments, dangerous journeys to medical facilities, and further pressure on already weakened health systems.
The Central African Republic illustrates the scale of the problem. Women there are about 40 times more likely to die during pregnancy or childbirth than women in the United States, according to the United Nations. The country records 829 maternal deaths for every 100,000 live births, while more than 40% of births take place outside medical facilities.
Years of internal conflict have left the country’s health system fragile, with services particularly scarce outside major cities. Despite its large gold reserves, one in three people lives on less than $2 a day. In 2024, the government announced a plan to increase spending on resources including skilled birth attendants, but officials did not respond to questions about how the program has progressed.
Meanwhile, cuts in humanitarian funding have made access to care even more difficult. In the remote town of Birao, near the Sudanese border, four local midwives supported by the UN Population Fund lost their jobs last year after the Trump administration ended U.S. funding agreements with UNFPA. Four UNFPA-funded “safe spaces” that provided transport for pregnant women to the district hospital also closed. The facilities had served nearly 50,000 women in Birao. Two U.S.-backed health facilities were also shut down.
UNFPA’s budget in the Central African Republic has fallen by half over the past two years to $6.5 million, according to country director Victor Rakoto. The agency had also been the only provider of reproductive health products in Birao. “The risk of maternal death is going to increase if there is no solution,” Rakoto said.
The strain is visible at Birao’s district hospital, which serves about 70,000 people as well as 22,000 Sudanese refugees. The maternity ward has only eight beds in a room so small that they almost touch. Some women walk for hours to reach the hospital; others make the journey by motorcycle over rough roads.
The trip can be particularly difficult for refugees. From the Sudanese border, the journey to the camp is about 65 kilometers, while the hospital is several kilometers farther along dirt roads. Health workers say many women arrive only when they are about to give birth, despite WHO guidance recommending at least eight prenatal consultations during pregnancy.
Aid cuts have also reduced the number of health workers. Doctors said 12 staff members lost their jobs, most of them from the maternity department. Four were midwives who had been working in Birao when the number of women arriving at the hospital tripled after Sudan’s war began in early 2023. Supplies such as antibiotics and malaria treatments also became harder to obtain.
The consequences can be devastating. A Sudanese refugee, Amna Adam Hessen, arrived at the hospital with malaria and a fever. Doctors discovered that her baby was in a breech position, but the problem was identified late after she missed prenatal appointments. She was brought from the refugee camp by motorcycle, suffered heavy bleeding during labor, and lost the baby.
For another refugee, Katidje Idrisse Tahire, the uncertainty is still ahead. Nine months pregnant, she fled Sudan on foot four months earlier and was robbed by armed men at the border. Her husband remains missing. With no money and no certainty that medical care will be available when labor begins, she is preparing to give birth in the same strained system.
Across the Central African Republic, the combination of poverty, displacement, conflict, and shrinking health services is making childbirth more dangerous. In a region already carrying the world’s heaviest burden of maternal and newborn deaths, the risks are rising precisely where women have the fewest options for obtaining care.
