Born on the road: Aid cuts leave refugee mothers with nowhere to turn

When labour pains struck Sudanese refugee Maude Ahmad Fadala, there was no clinic nearby, no transport and no money to reach a hospital. Hours later, weakened by illness and stranded on a dirt road in northern Central African Republic, she gave birth with only her sister by her side.

The agony began shortly after sunset at the Korsi refugee camp near the Sudanese border. Fadala, who had fled Sudan's war, was suffering from typhoid when labour started.

With no functioning maternal health services in the camp and no money for transportation, she began the journey to the district hospital on foot. But the distance proved too great.

Forced to stop repeatedly as contractions intensified, she eventually collapsed by the roadside and gave birth without medical assistance.

“I didn’t know about the baby. I don't know what a nurse does to make a newborn cry,” Fadala said. “My baby and I were sick.”

Her experience illustrates the growing dangers facing thousands of displaced women in one of the world's most fragile health systems.

A crisis beyond the border

For women fleeing Sudan's conflict, reaching safety does not mean escaping risk.

Displacement often disrupts prenatal care, limits access to skilled birth attendants and places pregnant women in remote areas where healthcare facilities are scarce.

According to the United Nations, women in the Central African Republic are 40 times more likely to die during pregnancy or childbirth than women in the United States. The country records 829 maternal deaths for every 100,000 births, among the highest rates in the world.

Years of instability and conflict have weakened public services, particularly outside major cities. Poverty remains widespread, with one in three people living on less than two dollars a day.

The impact of aid cuts

Humanitarian organisations warn that recent funding reductions are worsening an already critical situation.

In Birao, a remote town near the Sudan border where many refugees have settled, four midwives supported by the United Nations Population Fund (UNFPA) lost their jobs last year after funding was cut.

The closures followed a decision by the United States government to end all funding agreements with the UN agency responsible for sexual and reproductive health programmes.

Several services that once supported pregnant women have since disappeared.

Opposite Fadala's tent stands a former UNFPA-funded safe space that previously arranged transportation for expectant mothers to the district hospital. It was one of four centres serving nearly 50,000 women in the area.

All have now shut their doors. Two health facilities supported through U.S. funding have also closed.

Women left exposed

The loss of services is forcing women to carry pregnancies without medical supervision and deliver babies without professional support.

“I think the funding cuts reduced the population’s access, especially women’s access, to maternal health services,” said Marie Justine Mamba Ibingui, a UNFPA specialist working on gender-based violence.

“Today, women no longer have access to those services. Therefore, some women run the risk of dying in pregnancy situations that are not medically managed.”

At Birao District Hospital, staff are seeing the consequences firsthand.

“All the women who don’t come in for checkups, when they come here to give birth, it's a struggle,” said birth assistant Delphine Zanabe. “It's either the baby or the mother who suffers.”

A global challenge concentrated in conflict zones

The World Health Organization estimates that nearly two-thirds of maternal deaths worldwide occur in countries affected by conflict or fragility.

Conflict-affected settings account for six in ten maternal deaths globally, according to the United Nations.

The government of the Central African Republic announced plans in 2024 to increase spending on maternal healthcare and skilled birth attendants. However, questions remain over how effectively those commitments are being implemented.

For women like Fadala, the consequences of those gaps are measured not in statistics but in survival.

Her journey to safety ended at the border. Her struggle to give birth safely did not.