GOMA, Congo– In a maternity ward in eastern Congo, Irène Nabudeba placed her hands on her bulging belly, worried about giving birth in a town under rebel control.
The conflict that erupted this year has left many medical supplies stranded beyond the front line. Infrastructure like running water has collapsed, as has the economy of Goma, the region’s humanitarian and commercial hub.
And now the only glimmer of hope for mothers – a free maternity care program offered by the Congolese government – has ended after it was not renewed in June. It is unclear why and Congolese officials did not respond to questions.
Nabudeba has five children and wonders if the sixth will survive.
“At the hospital, they ask us for money that we don’t have. I force myself to come to consultations, but for the birth… I don’t know where I will find the money,” she said at the Afia Himbi health center.
Several women told The Associated Press they could not afford maternal care after Congo’s program aimed at reducing some of the world’s highest maternal and newborn mortality rates ended earlier this year. The program launched in 2023 offered free consultations and treatment for illnesses and high-risk pregnancies at select health facilities across the country.
Congo ranks second in the world for maternal deaths with 19,000 in 2023, behind Nigeria’s 75,000 deaths, according to UN statistics.
Health workers said that in Goma, more women are now giving birth at home without skilled assistance, sometimes in unsanitary conditions, leaving them vulnerable to hemorrhage, infection or death.
Clinics and hospitals were already struggling after M23 rebels, backed by neighboring Rwanda, seized Goma in an escalation of fighting in January.
Although clashes have subsided thanks to peace efforts led by the United States and Qatar, fighting has intensified again in recent days and the conflict has collapsed public institutions, disrupted essential services and displaced more than 700,000 people, according to the U.N. humanitarian office.
In Goma, armed rebels are visible everywhere, making a pregnant woman’s journey to clinics another source of anxiety.
Freddy Kaniki, deputy coordinator of M23, told the AP that free maternal care “was not renewed because it was a failure,” without further details. Congolese officials did not respond to questions.
Rwanda denies supporting the M23, although UN experts say they have proof. Rwanda prides itself on its health care and recently signed a five-year agreement with the United States for an investment of up to $158 million in its own health sector.
The collapse of essential services in rebel-held areas, combined with mass displacement and insecurity, has left civilians struggling to access even basic healthcare.
An assessment by the International Committee of the Red Cross in September found that at least 85% of health facilities were experiencing drug shortages and that almost 40% of them had experienced an exodus of staff after the escalation of conflict in North Kivu and South Kivu provinces.
The ICRC said in October that 200 health facilities in eastern Congo were running out of medicine due to looting and supply disruptions. Doctors Without Borders, or MSF, has reported hospitals attacked, ambulances blocked and medical staff threatened or killed.
Giving birth in a clinic in Goma now costs between $5 and $10, out of reach for many families in a region where more than 70% of the population lives on less than $2.15 a day, according to the World Bank.
Franck Ndachate Kandonyi, head nurse at the Afia Himbi health center, said the number of births under the free program had increased from about five a month to more than 20. But the program ended in June.
Facing a table of statistics in his office, Kandonyi said the number of births per month had now fallen to nine.
“When a parent can’t even pay 10,000 Congolese francs ($4.50) for the care of their wife or children, it’s a real problem,” the nurse said.
Meanwhile, banks closed in Goma, prices rose and the franc depreciated.
Nabudeba’s husband, a driver, has been unemployed since January. She said her family is barely surviving.
“When the war broke out, we lost all our resources,” she said. “Recently the situation has not been favorable and we are suffering greatly. »
Across town, at the Rehema health center, Ernestine Baleke waited for help with her ninth pregnancy, her face worried. She said she didn’t know where she would get money for delivery.
Her husband lost a job in a factory when the place was looted at the start of the conflict, she said. Then their house burned down.
“I don’t even have 100 francs (45 centimes) in my pocket,” Baleke said.
She walks more than half a mile to the hospital because she can’t afford transportation. There are three months left before her due date.
“The authorities must restore free health care,” Baleke said. “We risk dying at home while giving birth. »
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