Uncertain labor: Central Africa’s maternal mortality crisis

Jeanine was sitting in the middle of the road in Birlo, a village just outside of Bangui, Central African Republic’s capital. The 39-year-old woman, who suffers from mental and physical disabilities, was two months pregnant with her third child. The victim of a rape, Jeanine had no choice but to have the baby, not only because her family wouldn’t accept an abortion but also because they wouldn’t be able to afford it.

Photographer Nicole Tung met Jeanine as Tung worked on a project, supported by the International Women’s Media Foundation, about the Central African Republic’s maternal health care. The country has one of the worst maternal mortality rates in the world, second only to Sierra Leone. With 882 deaths for every 100,000 successful births, it’s far behind countries such as the United States, which recorded 14 out of 100,000.

“Jeanine’s story really marked me because it was representative of the many factors contributing to the high rate of maternal mortality,” Tung said, even if Jeanine’s situation was extreme.

Almost five years after a cease-fire was signed, the country continues to suffer from flare-ups in fighting as some militias adopt a tit-for-tat mentality in a civil war that has reshaped the country, destroyed much of its infrastructure and rendered rural areas outside the capital unsafe.

All of these factors have worsened the quality and availability of health care for women.

“An estimated 35 percent of medical facilities have been damaged or destroyed in the past six years,” Tung said, “preventing women from accessing clinics and hospitals, and hindering the work of community health-care workers and midwives.” Plus, there is a lack of qualified doctors not only to treat patients but also to offer family planning education.

Tung doesn’t see the situation improving soon. “I think, for most women who live in the areas outside of the capital, their futures will remain much the same,” she said. “In the capital, although medical services are available, they are rudimentary and very limited. Many clinics I visited didn’t have running water or soap.”

The saving grace, though, is a Doctors Without Borders’ hospital dedicated to maternal health care in Bangui, she said. “Most prospective mothers in the capital have a safety net in case of complications, but that’s not the case for women outside of Bangui.”