Stories from women in some of the world’s most remote places reveal that challenges of giving birth without losing their lives are strikingly similar across continents. And they are preventable.
“I don’t know what will become of her. She’s a girl”
Hermina lives in the Central African Republic (CAR), Murjanatu in northern Nigeria, and Sabera is a Rohingya refugee in Bangladesh. Though they live in vastly different places, the struggles they have faced simply for being pregnant bring them closer together.
“I walked from five to nine in the morning. I had to come alone—my parents arrived the next day. My husband wanted to come, but his bicycle broke down,” says Hermina Nandode, cradling her baby wrapped in a colourful blanket. She’s speaking from Batangafo hospital in northern CAR, where some women travel up to 100 kilometres to receive medical care during pregnancy.
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 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.” Some health centres only operate until early afternoon. And in some cases, due to insecurity, there’s no available trained staff or drugs to de administered.
In northern Nigeria, Murjanatu is waiting at MSF-supported Shinkafi General Hospital before being transferred to a referral hospital to treat her severe anaemia. She delayed seeking care due to the cost, even for basic pregnancy check-ups.
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.”
Raquel Vives, a midwife and sexual and reproductive health expert with Médecins Sans Frontières (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,” she 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.”
Many of the complications that threaten the lives of pregnant women and girls are preventable. The most common causes include haemorrhage, obstructed labour and infections. Undiagnosed hypertension can also lead to eclampsia —a life-threatening condition.
Madina Salittu, a midwife at Shinkafi General Hospital, explains: “Sometimes hypertension is linked to insecurity, fear and anxiety. Many women don’t have access to antenatal care and their blood pressure is not monitored.” Anaemia is another major risk factor linked to obstetric complications. “If we receive 90 pregnant women, it’s likely that 70 will be anaemic, which increases the need for blood transfusions,” adds MFS’s Otse.
Alida Fiossona, is expecting her third child at the Bignola, a maternity waiting home set up by MSF 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 marginalise those who come to the waiting home. But my health is more important—their opinions don’t matter.” Cultural beliefs can be powerful barriers, adds Otse. “If you give birth at home, you’re seen as a strong woman. If you go to hospital, you’re not.”
Many of the complications that threaten the lives of pregnant women and girls are preventable. The most common causes include haemorrhage, obstructed labour and infections. Undiagnosed hypertension can also lead to eclampsia —a life-threatening condition.
Madina Salittu, a midwife at Shinkafi General Hospital, explains: “Sometimes hypertension is linked to insecurity, fear and anxiety. Many women don’t have access to antenatal care and their blood pressure is not monitored.” Anaemia is another major risk factor linked to obstetric complications. “If we receive 90 pregnant women, it’s likely that 70 will be anaemic, which increases the need for blood transfusions,” adds MFS’s Otse.
Alida Fiossona, is expecting her third child at the Bignola, a maternity waiting home set up by MSF 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 marginalise those who come to the waiting home. But my health is more important—their opinions don’t matter.” Cultural beliefs can be powerful barriers, adds 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. 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,” says Vives. “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 MSF-supported Batangafo hospital, explains that 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. To go to hospital, you need clothes for yourself and the baby—but we couldn’t afford even that. And I don’t speak Sango,” Honorine explains. 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. But after what I’ve seen, if I get pregnant again, I’ll do everything I can to go to a hospital,” she adds. “I’ve put everything else aside because I want to go home with my baby—and healthy.”
In 2024, MSF teams worldwide assisted more than 1,000 births per day—369,000 in total. Fifteen per cent of those took place in Nigeria, the Central African Republic 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.
“We use decentralised 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.”
Vives adds: “When complications arise, speed is critical – but predicting them isn’t always possible.”
“Here, 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,” adds midwife Madina in Shinkafi. Where possible, MSF supports peripheral health posts to refer women with complications and operates a network of motorbike riders to navigate the difficult terrain of remote areas.
“Maternal mortality,” reflects Raquel Vives, “points to many factors that generally threaten women’s health and rights—factors that often remain in the shadows. 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.”
