The shared challenges of giving birth

“Maternal mortality points to many factors that generally threaten women’s health and rights — factors that often remain in the shadows,” Vives explains. Due largely to gender inequality, “women often lack the autonomy, resources, or decision-making power needed to access timely and safe care.”

The stories of MSF maternity patients from Nigeria, Central African Republic (CAR), and Bangladesh highlight the shared challenges pregnant women face around the world, even in vastly different settings thousands of miles apart.

Long distances and lack of transportation to health facilities

In many of the places where MSF works, health facilities are few and far between, so people have to travel long distances to access care. Insecurity and lack of transportation options make these facilities even more difficult to reach. 

“The difficulties begin with limited access to obstetric care due to the lack of health centers,” says Nadine Karenzi, medical lead for MSF in Batangafo in CAR. “Then there’s the distance between villages and clinics, the lack of transport, insecurity, and the cost of travel.” 

At the MSF-supported Batangafo Hospital in CAR, some women travel up to 60 miles for prenatal care.

“I walked from 5 to 9 in the morning,” says Hermina, maternity patient. “I had to come alone — my husband wanted to come, but his bicycle broke down.” Hermina is a patient at Bignola, a “waiting home” maternity ward MSF set up next to Batangafo Hospital to ensure pregnant women with identified risk factors receive timely care. 

“Before this maternity home was set up, many women lost their babies on the way to distant health centers,” says Ruth Mbelkoyo, an MSF staff member. “Some even lost their own lives. I remember one woman from Kabo [a town 35 miles 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.”

Another patient at Bignola, Honorine, has been pregnant 10 times, though only six of her children survived. Due to the complications she faced during her previous pregnancies, and the advice of community health workers near her village, she decided to seek hospital care. Now she will give birth in a hospital for the first time.

“After what I’ve seen, if I get pregnant again, I’ll do everything I can to go to a hospital,” says Honorine. “I’ve put everything else aside because I want to go home with my baby.” 

In Nigeria, MSF teams support peripheral health posts to refer women with complications and operate a network of motorcyclists to navigate rough terrain in remote areas. “We use decentralized models of care,” says Patience Otse, MSF’s midwife supervisor in Shinkafi, Zamfara state. “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 centers and this hospital.”

Prohibitive costs of care

Affordability is another major factor preventing many people worldwide — including women with high-risk pregnancies — from accessing the care they need.

“To go to hospital, you need clothes for yourself and the baby — but we couldn’t afford even that,” says Honorine. 

Thousands of miles away, in Cox’s Bazar, Bangladesh — the world’s largest refugee camp, housing over 1 million Rohingya refugees — another MSF patient, Sabera, shares a similar sentiment: “Sometimes we have to sell household items or borrow money to get to the hospital in a medical emergency.”

Financial barriers to care can have serious consequences for pregnant women, especially those with complications. At the MSF-supported Shinkafi General Hospital in northern Nigeria, one patient, Mahmuda, developed severe anemia and had to be transferred to a referral hospital for treatment. She said she had delayed seeking care due to the cost of pregnancy check-ups.

“If you don’t have money, you can’t even go for prenatal consultations,” Mahmuda says. “No one will see you unless you pay.”

Anemia is a 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 Madina Salittu, a midwife at Shinkafi General Hospital. “Many women don’t have access to prenatal care and their blood pressure is not monitored. Sometimes hypertension is linked to insecurity, fear, and anxiety.”

Many of the complications that threaten the lives of pregnant women and girls are preventable. The most common causes include hemorrhage, obstructed labor, and infections. Undiagnosed hypertension can also lead to eclampsia, which is a life-threatening condition.

Overcoming cultural stigmas to access prenatal care

“Some husbands allow their wives to go to hospital, but others don’t,” says Sabera, who is close to delivering her sixth child. This one of the most widespread barriers women face.

“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 Otse. “Sometimes the husband is not even home, so she has to stay home and wait for him to return.”

“If you give birth at home, you’re seen as a strong woman,” says Otse. "If you go to hospital, you’re not.”

During prenatal consultations at MSF’s Goyalmara Mother and Child Hospital in Cox’s Bazar, our teams raise awareness about family planning during prenatal consultations, which often involves addressing cultural stigmas. “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,” says Dinatunessa, an MSF midwife.

Reducing barriers that put women’s lives at risk

In 2024, MSF teams worldwide assisted more than 1,000 births per day — 369,000 in total. Fifteen percent of those took place in Nigeria, CAR, and Bangladesh. 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.

To prevent maternal deaths, 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. Further humanitarian funding cuts will only deepen the crisis, putting thousands of women and newborns at greater risk.”

One of the leading causes of maternal mortality worldwide is unsafe abortion — one that’s carried out by someone who does not have the necessary skills to perform it, or does not comply with medical standards. Unsafe abortions often result in severe and life-threatening complications. 

“When it is not fatal, it can still lead to long-term consequences such as infertility and chronic pain,” adds Vives. “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.”