The Central African Republic (CAR) has one of the highest maternal mortality rates in the world, at 835 deaths per 100,000 live births. A shortage of skilled health care providers and an unequal distribution of health services drive these high maternal deaths. Preventable conditions such as postpartum hemorrhage, hypertension and sepsis fuel the risks. These challenges explain why helping community midwives reduce maternal deaths in the CAR remains essential, especially in communities facing rapid population growth and limited services to support them.

Rural areas record only 28% of deliveries assisted by a skilled worker and just 2% of deliveries receive surgical assistance. The World Health Organization (WHO), UNICEF and the International Medical Corps expand access to maternal health care, train community midwives and strengthen rural health systems.

Training Community Midwives to Deliver Safer Births

WHO trains and deploys community midwives to expand access to skilled care. Fewer than half of pregnant women in CAR attend fewer than the four recommended antenatal consultations, with most deliveries occurring at home. By placing midwives directly within communities, WHO reduces the distance and cost barriers that prevent many women from seeking care.

Community midwives build trust and encourage families to seek skilled delivery services. In 2024, WHO equipped 30 maternity wards with essential medical equipment and medicines to improve the safety and dignity of maternal care. These improvements ensure that midwives can manage complications more effectively and women receive specialized and emergency care.

Community midwives help lower maternal deaths in the CAR.

Improving Access to Maternity Services

Rural communities in CAR face significantly higher risks during pregnancy and childbirth. Although understanding of midwifery care is increasing, many women still cannot reach health facilities.

UNICEF works to reduce delays in antenatal consultations and ensure that women receive timely and appropriate care. This support operates in five of the country’s 35 health districts. Bossangoa, a district of 176,688 people, shows the impact of this initiative. The regional hospital sits more than 90 kilometers from the farthest village, which makes access difficult. These long distances often force women to give birth at home without skilled assistance, increasing the likelihood of preventable complications.

In Nodokota, a local matron, Adele, received hands-on obstetric and neonatal training supported by UNICEF and donor funding. These practical skills improve conditions in remote communities and contribute to helping community midwives reduce maternal deaths in the CAR.

Establishing New Midwife Training Schools

To strengthen maternal health care, the Ministry of Health and Bangui University partnered with the International Medical Corps to establish the Bria Auxiliary Midwife Training School in 2024. The school serves a remote region of more than 150,000 people and offers a two-year certification program based on French Red Cross curriculum adapted to national and international standards.

This program covers prenatal care, labor and delivery, postpartum care, family planning and newborn care. Enrollment reached 51 students by November 2024, with graduates expected in 2026. These trained auxiliary midwives will return to their rural communities with the skills needed to support mothers and newborns. By expanding the midwifery workforce, the program advances helping community midwives reduce maternal deaths in the CAR.

Strengthening Midwifery Leadership

In 2024, African midwives gathered in Ghana to discuss a new advisory body to represent midwifery across the continent. The summit brought together midwifery associations and young midwives and emphasized leadership development and equitable representation.

With 70% of the population under 30, investing in young midwives strengthens the future of maternal health. The movement also focuses on shaping maternal care around African realities and ensuring midwives closest to communities guide decision-making. This approach shifts influence toward local practitioners who understand the community needs and the barriers women face when seeking care. It also helps build a new generation of midwifery leaders who can advocate for stronger policies and more equitable health systems.

This regional collaboration supports long-term progress in helping community midwives reduce maternal deaths in the CAR.

Final Thoughts

These initiatives transform maternal health in the CAR by expanding access to health care, strengthening midwife training and improving services in rural areas. This support is especially important because most medical personnel work in urban centers, which leaves rural communities underserved. Through the efforts of WHO, UNICEF, the International Medical Corps and regional midwifery leaders, community midwives are increasingly equipped to provide safe, skilled care and continue helping community midwives reduce maternal deaths in the CAR.

– Flora de Leeuw

Flora is based in Bath, UK and focuses on Good News and Global Health for The Borgen Project.

Photo: Flickr