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 Nandode, 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 down.” 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 be administered.

In northern Nigeria, Murjanatu is waiting at Shinkafi General hospital, where MSF works, 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,” she says. “No one will see you unless you pay.”

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,” she says. 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 at Shinkafi General in Nigeria. “Sometimes the husband is not even home, so she has to stay home and wait for him to return.”

Raquel Vives, a midwife and sexual and reproductive health expert with 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,” says Vives. “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,” she adds.

Many of the complications that threaten the lives of pregnant women and girls are preventable. The most common include haemorrhage, obstructed labour, and infections. Undiagnosed hypertension can also lead to eclampsia — a life‑threatening condition.

Madina Salittu, a midwife at Shinkafi General, 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, from CAR, is expecting her third child at the Bignola, a home set up by MSF next to Batangafo hospital, where women with identified risk factors can stay as they wait to give birth. Beyond medical concerns, Alida points to the social stigma many women face.

“Some people mock and marginalise those who come to the waiting home,” says Alida. “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,” she says.

“One of the most significant – yet often overlooked – causes of maternal mortality is unsafe abortion,” says Vives. “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.”

“Across the contexts where we work, restrictive laws, stigma, and lack of access to contraception push women into dangerous abortion procedures,” says Vives.

Language is yet another obstacle. Emmanuelle Bamongo, a midwife in Batangafo hospital, where MSF works, 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 10 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,” says Honorine. “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.” 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,” she says. “But after what I’ve seen, if I get pregnant again, I’ll do everything I can to go to a hospital. 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 60 kilometres 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.”

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 health centres and this hospital.”

Vives adds: “When complications arise, speed is critical – but predicting them isn’t always possible.”

“Here [Shinkafi General hospital], MSF covers many needs—from food and medicine to surgery when needed,” says Madina, a midwife at the hospital. “Transport is also provided, both to the hospital and back to their communities.”

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.

“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, Bangladesh. “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.”

“Maternal mortality points to many factors that generally threaten women’s health and rights—factors that often remain in the shadows,” says Vives. “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,” she adds.

After three weeks at the 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,” Hermina says. “She’s a girl.”