Maternal health: “I don’t know what will become of her. She’s a girl”
From Bangladesh to Central African Republic to Nigeria, women face preventable, life-threatening risks in childbirth.
Stories from women in some of the world’s most remote places reveal that the challenges of giving birth safely are strikingly similar across continents. And they are preventable.
Three women living in vastly different places are brought together by shared challenges during pregnancy: Hermina in Central African Republic (CAR), Murjanatu in northern Nigeria and Sabera in Bangladesh.
“I walked from five to nine in the morning,” says Hermina, cradling her baby wrapped in a colourful blanket. “I had to come alone — my parents arrived the next day. My husband wanted to come, but his bicycle broke down.” She delivered her baby care at Batangafo hospital in northern CAR, where some women travel up to 100 kilometres to receive medical care during pregnancy.
“In many places where we work, resources barely function even for uncomplicated deliveries. Eventual further humanitarian funding cuts will only deepen the crisis, putting thousands of women and newborns at greater risk.”
Raquel Vives, MSF midwife and sexual and reproductive health expert
These women’s stories echo one another. So do the diagnoses from the health workers who care for them.
“The difficulties begin with limited access to obstetric care due to the lack of health centres,” says Nadine Karenzi, medical lead for Doctors Without Borders/Médecins Sans Frontières (MSF) in Batangafo. “Then there’s the distance between villages and clinics, the lack of transport, insecurity and the cost of travel.”
At the same time, some health centres only operate until early afternoon. And in some cases, due to insecurity, there’s no available trained staff or drugs to be administered.
In northern Nigeria, Murjanatu is waiting at the MSF-supported Shinkafi general hospital before being transferred to a referral hospital to treat her severe anemia. She delayed seeking care due to the cost, even for basic pregnancy check-ups.
“If you don’t have money, you can’t even go for prenatal consultations,” Murjanatu says. “No one will see you unless you pay.”
Some women travel over 200 kilometres to Shinkafi to access MSF’s free services.
“Some husbands allow their wives to go to hospital, but others don’t”
In Cox’s Bazar, Bangladesh, Sabera shares a similar experience. “Sometimes we have to sell household items or borrow money to get to the hospital in a medical emergency.” Now close to delivering her sixth child, she highlights one of the most widespread barriers women face: “Some husbands allow their wives to go to hospital, but others don’t.”
“A woman can be suffering at home, even bleeding or facing a serious complication, but she is not allowed to go to hospital without her husband’s permission,” says Patience Otse, MSF midwife supervisor in Shinkafi. “Sometimes the husband is not even home, so she has to stay home and wait for him to return.”
Raquel Vives, a midwife and sexual and reproductive health expert with MSF, says maternal deaths often go unseen. Yet the UN warns that every two minutes a woman dies from complications of pregnancy or childbirth.
“These are not inevitable tragedies – most could be prevented with timely care,” Vives says. “The key is ensuring as many women as possible can give birth in a health facility with skilled birth attendants. But in many places where we work, resources barely function even for uncomplicated deliveries. Eventual further humanitarian funding cuts will only deepen the crisis, putting thousands of women and newborns at greater risk.”
“Cultural beliefs can be powerful barriers. If you give birth at home, you’re seen as a strong woman. If you go to hospital, you’re not.”
Patience Otse, MSF midwife supervisor in Shinkafi
Many of the complications that threaten the lives of pregnant women and girls are preventable. The most common causes include hemorrhage, obstructed labour and infections. Undiagnosed hypertension (high blood pressure) can also lead to eclampsia — a life-threatening condition.
“Sometimes hypertension is linked to insecurity, fear and anxiety,” says Madina Salittu, a midwife at Shinkafi general hospital. “Many women don’t have access to prenatal care and their blood pressure is not monitored.”
Anemia is another major risk factor linked to obstetric complications. “If we receive 90 pregnant women, it’s likely that 70 will be anemic, which increases the need for blood transfusions,” says Otse.
Alida is expecting her third child at the Bignola, a maternity waiting home MSF set up next to the Batangafo hospital to ensure women with identified risk factors receive timely healthcare. Beyond medical concerns, Alida points to the social stigma many women face. “Some people mock and marginalize those who come to the waiting home. But my health is more important — their opinions don’t matter,” she says.
“Cultural beliefs can be powerful barriers,” says Otse. “If you give birth at home, you’re seen as a strong woman. If you go to hospital, you’re not.”
“One of the most significant – yet often overlooked – causes of maternal mortality is unsafe abortion,” says Vives. “When it is not fatal, it can still lead to long-term consequences such as infertility and chronic pain. In many of our projects, we regularly treat women with severe, life-threatening complications after abortions carried out by themselves or untrained individuals in unhygienic conditions. Across the contexts where we work, restrictive laws, stigma and lack of access to contraception push women into dangerous abortion procedures.”
Language is yet another obstacle. Emmanuelle Bamongo, a midwife in the MSF-supported Batangafo hospital, says many women are reluctant to come to the waiting home for fear of being mocked for not speaking Sango, the dominant language. That was the case for Honorine, who has been pregnant ten times, though only six of her children survived. Now at Bignola, it’s the first time she will go to a hospital to give birth.
“I want to go home with my baby and healthy”
“We have no money,” says Honorine. “To go to the hospital, you need clothes for yourself and the baby — but we couldn’t afford even that and I don’t speak Sango.”
Her decision to seek care was influenced by the complications she faced in previous pregnancies and the advice of community health workers near her village.
“Before, I was ashamed of having nothing,” Honorine says. “But after what I’ve seen, if I get pregnant again, I’ll do everything I can to go to a hospital. I’ve put everything else aside because I want to go home with my baby — and healthy.”
“Before this maternity home was set up, many women lost their babies on the way to distant health centres,” says Ruth Mbelkoyo, an MSF staff member. “Some even lost their own lives. I remember one woman from Kabo [a town 60 kilometres from Batangafo] who had lost her first three pregnancies. For the fourth, she came to the hospital and was able to deliver her baby safely.”
In 2024, MSF teams around the world assisted more than 1,000 births per day — totalling 369,000 throughout the year. Fifteen per cent of those births took place in Bangladesh, Central African Republic and Nigeria. But the work goes far beyond the delivery room: MSF aims to reduce the delays and barriers that put pregnant women’s lives at risk.
“We use decentralized models of care,” says Otse. “Our teams can’t always reach the women who need us, so we work with traditional birth attendants and community midwives who help with deliveries and refer complicated cases to primary health centres and this hospital.”
“When complications arise, speed is critical – but predicting them isn’t always possible,” says Vives.
“Gender inequality further exacerbates these risks, as women often lack the autonomy, resources, or decision-making power needed to access timely and safe care.”
Raquel Vives, MSF midwife and sexual and reproductive health expert
“Here [the Shinkafi general hospital], MSF covers many needs—from food and medicine to surgery when needed. Transport is also provided, both to the hospital and back to their communities,” says Madina, a midwife at the hospital. Where possible, MSF supports peripheral health posts to refer women with complications and operates a network of motorbike drivers to navigate the difficult terrain in remote areas.
“We also try to raise awareness about family planning during prenatal consultations,” says Dinatunessa, a midwife at the MSF Goyalmara mother and child hospital in Cox’s Bazar. “We do our best to explain the benefits of spacing pregnancies and the methods available, but some women have little support from their husbands on this matter.”
“Maternal mortality points to many factors that generally threaten women’s health and rights — factors that often remain in the shadows,” says Vive. “Beyond the obvious impact on the survival of their children, every mother who dies makes those same risks even harder for the next generation. Gender inequality further exacerbates these risks, as women often lack the autonomy, resources or decision-making power needed to access timely and safe care.”
After three weeks at Bignola and having safely delivered her baby, Hermina smiles. But her expression quickly shifts to concern.
“I don’t know what will become of her,” she says softly. “She’s a girl.”
