The fight to give birth safely
Every two minutes, a woman dies from pregnancy or childbirth complications worldwide.
These maternal deaths are often linked to the “three delays”: the delay in deciding to seek care, the delay in reaching a healthcare facility, and the delay in receiving timely treatment.
As MSF maternity teams around the world support an average of 1,000 deliveries every day, they work hard to address the challenges facing women giving birth, which are strikingly similar across continents.
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,” 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.”
She’s speaking from Batangafo Hospital in northern CAR, where some women travel over 60 miles 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 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 be administered.
Our work saves lives
High costs and a husband's permission
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.
“If you don’t have money, you can’t even go for antenatal consultations. No one will see you unless you pay.”
Some women travel over 120 miles to Shinkafi to access MSF’s free services.
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’s midwife supervisor in Shinkafi.
“Sometimes the husband is not even home, so she has to stay home and wait for him to return.”
“These are not inevitable tragedies – most could be prevented with timely care”
Raquel Vives, a midwife and sexual and reproductive health expert with MSF says maternal deaths often go unseen. “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.”
The complications and misconceptions that kill
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 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.”
Seeking care despite the fear
Language is yet another obstacle. Many women near Batafango Hospital in CAR are reluctant to seek maternity care 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 the MSF maternity waiting home, it’s the first time she will go to a hospital to give birth.
“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.”
“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 37 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.”
Reducing delays and barriers
In 2024, MSF teams worldwide assisted more than 369,000 births, fifteen percent of which 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.
Hawa Tauko Audu, a health promoter in the Nigerian town of Maiduguri says, “because many people can’t afford health services provided in other facilities, a lot of women here give birth at home. We inform them that MSF is free, and provides ante-natal and post-natal care. Now, due to the presence of MSF and our health promoters, more people are delivering in hospitals.”
“We also try to raise awareness about family planning during antenatal 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.”
369,000
the number of births MSF teams assisted worldwide in 2024
Inequality and a lack of agency
“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.”
MSF maternity care
Our healthcare teams work together with pregnant women to provide delivery services, emergency obstetric care and post-delivery consultations.
We work with midwives and traditional birth attendants to establish programmes so complicated births can be identified quickly to help prevent maternal deaths.