Full Breakdown
Maternal Care Crisis Deepens in Birao Amid Aid Cuts
6/4/2026, 5:33:09 AM
The Immediate Crisis: Births Without Care
In the Birao refugee camp near the Sudan border, women are giving birth on streets and in makeshift shelters. Maude Ahmad Fadala, weakened by typhoid, walked until she could no longer continue and delivered her child in the street with no medical assistance. Birthing assistant Delphine Zanabe reports that most women arrive only when labor is imminent, forcing a choice between the mother’s and the baby’s survival.
Context: Conflict, Fragility, and Funding Reductions
Decades of internal conflict have left the Central African Republic’s (CAR) health system fragile. Despite gold reserves, health services are scarce outside major cities, and one-third of the population lives on less than $2 a day. The 2024 government plan to increase spending for skilled birth attendants has not been evaluated, and officials have not answered queries about its impact. Simultaneously, sweeping cuts to humanitarian aid—most notably the United States’ termination of all funding agreements with the UN Population Fund (UNFPA)—have eliminated four UNFPA-supported “safe spaces” and two U.S.–backed health facilities in Birao.
Key Actors on the Ground
- UNFPA Program Officer: Marie Justine Mamba Ibingui, who warns of rising maternal-death risk.
- UNFPA Country Director: Victor Rakoto, noting the agency’s budget halved to $6.5 million.
- Midwives: Clara Abessendé and three colleagues who lost their jobs after funding cuts.
- Birthing Assistant: Delphine Zanabe, overseeing a crowded maternity ward with eight beds serving roughly 70,000 people and 22,000 Sudanese refugees.
Statistics Highlighting the Emergency
- CAR’s maternal mortality rate: 829 deaths per 100,000 births—about 40 times the U.S. rate.
- Over 40 % of births in CAR occur outside medical facilities (UN estimate).
- Conflict-affected settings account for six in ten global maternal deaths.
- Twelve staff members, primarily from the maternity department, have been laid off due to aid cuts.
Official Responses and Policy Plans
UNFPA officials stress that the agency remains the sole provider of reproductive-health products in Birao and that the budget reduction threatens service continuity. The CAR government’s 2024 initiative pledges increased funding for skilled birth attendants, though its implementation details remain undisclosed. The World Health Organization highlights that nearly two-thirds of maternal deaths worldwide occur in conflict-or “fragile” nations.
Opposition and Critiques of Aid Reductions
Midwives and health workers describe a surge in infant and maternal deaths after the influx of Sudanese refugees in early 2023, attributing the rise to supply shortages and staff losses. Clara Abessendé expressed personal guilt over abandoning the children she once delivered. UNFPA’s budget cut is cited as a primary driver of the deteriorating situation.
Personal Accounts from Affected Women
- Maude Ahmad Fadala: “I gave birth in the street. There was no doctor, no midwife, and no one holding my hand.”
- Amna Adam Hessen: Arrived with malaria fever; a missed prenatal visit led to a breech presentation, heavy bleeding, and loss of her baby.
- Katidje Idrisse Tahiré: Fled Darfur, robbed at the border, now pregnant again with no money or guaranteed care.
Conflicting Data and Information Gaps
No official statistics are available on maternal outcomes in Birao since the aid cuts, and the government has not provided updates on the 2024 spending plan’s effectiveness. The extent of UNFPA’s remaining service capacity is unclear.
Verbatim Quotes
- “I gave birth in the street,” — Maude Ahmad Fadala, refugee
- “some women run the risk of dying in pregnancy situations that are not medically managed,” — Marie Justine Mamba Ibingui, UNFPA program officer
- “The risk of maternal death is going to increase if there is no solution,” — Victor Rakoto, UNFPA country director
- “They only come when they are about to give birth,” — Delphine Zanabe, birthing assistant
- “Giving birth here is exhausting,” — Amna Adam Hessen, patient
Outlook: What Lies Ahead
UN officials warn that continued funding reductions could exacerbate preventable deaths. Restoring UNFPA support and expanding skilled-birth-attendant programs are identified as urgent priorities to curb the rising maternal mortality in Birao and similar conflict-affected locales.
