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In a maternity ward in eastern Congo, Irene Nabudeba placed her hands on her bulging midsection, worried about giving birth in a rebel-controlled town.
The conflict that has erupted this year has left many medical supplies stranded beyond the front lines. In Goma, the humanitarian and commercial center of the region, the economy as well as basic infrastructure such as running water has collapsed.
And now one ray of hope for mothers – a free maternity care program offered by the Congolese government – has ended after not being renewed in June. It was not clear why, and Congolese and M23 officials did not respond to questions.
Nabudeba has five children and wonders whether the sixth will survive.
“At the hospital, they ask us for money that we don’t have. I’m putting pressure on myself to come for consultation, but for delivery… I don’t know where I’ll get the money,” she said at the Afia Himbi health centre.
Women are losing access to maternal care
Many women told The Associated Press they could no longer afford maternal care after Congo’s program, which aimed to reduce the world’s highest maternal and newborn mortality rates, ended earlier this year. The program, launched in 2023, offered free consultation and treatment for diseases and high-risk pregnancies at selected health facilities across the country.
Congo ranks second in maternal deaths globally with 19,000 in 2023 NigeriaAccording to UN figures, there were 75,000 deaths.
Health workers said more women in Goma are now giving birth at home without skilled help, sometimes in unsanitary conditions, putting them at risk of bleeding, infection or death.
Clinics and hospitals were already struggling after neighbors supported M23 rebels rwandaCaptured Goma in escalating fighting in January.
Essential services remain closed as fighting continues
Although clashes have subsided amid US and Qatar-led peace efforts, fighting continues and the conflict has demolished public institutions, disrupted essential services and displaced more than 700,000 people, according to the UN humanitarian office.
In Goma, armed rebels are seen everywhere, making a pregnant woman’s walk to a clinic yet another cause for concern.
M23 deputy coordinator Freddy Kanicki told the AP that free maternal care was not renewed because it had failed. Congolese officials did not respond to questions.
Rwanda has denied supporting the M23, despite UN experts saying they have evidence of it. Rwanda prides itself on healthcare and recently signed a five-year agreement with the US to invest up to $158 million in its healthcare sector.
Due to the collapse of essential services, mass displacement and insecurity in rebel-held areas, civilians struggle to access even basic care.
An International Committee of the Red Cross assessment in September found that at least 85% of health facilities were facing medicine shortages, and about 40% had seen staff flee as conflict escalated in the provinces. north kivu and South Kivu.
The ICRC said in October that 200 health facilities in eastern Congo had run out of medicines due to looting and supply disruptions. Doctors Without Borders, or MSF, has reported attacks on hospitals, blocking ambulances and medical staff being threatened or killed.
Some people may also pay $5 for medical assistance
According to the World Bank, the cost of giving birth at a clinic in Goma now ranges from $5 to $10, which is beyond the reach of many families in the region, where more than 70% of the population lives on less than $2.15 per day.
Frank Ndachetere Kandoni, head nurse at Afia Himbi Health Centre, said the number of births there has increased from about five per month to more than 20 under the free programme. But the program ended in June.
Facing a table of figures in his office, Candoni said the number of births per month had now dropped to nine.
“When a parent can’t even pay 10,000 Congolese francs ($4.50) to take care of his wife or child, it’s a real problem,” the nurse said.
Meanwhile, banks in Goma have closed, prices have risen and the value of the dollar has declined.
Nabudeba’s husband, a driver, has been unemployed since January. He said that his family is barely surviving.
“When the war broke out, we lost all our resources,” he said. “Recently, the situation has not been favorable, and we are suffering a lot.”
Across town at the Rehema Health Center, Ernestine Baleke was waiting for help with her ninth pregnancy, with worry on her face. He said that he does not know from where he will get the money for delivery.
She said her husband had lost his job at the factory when the place was looted in an earlier conflict. Then his house burnt down.
“I don’t even have 100 francs (45 cents) in my pocket,” Baleke said.
She walks more than half a mile to the hospital because she cannot afford transportation. There are still three months left for her delivery.
“The authorities should restore free health care,” Baleke said. “We risk dying while giving birth in our homes.”
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