A new report finds that most births in sub-Saharan Africa happen in facilities without basic sanitation, leaving millions of women exposed to preventable infections that can turn routine deliveries into life-threatening emergencies
In a maternity ward in northern Nigeria, Amina Yusuf once found herself facing a choice that no trained midwife should have to make. The clinic was overwhelmed after what she described as a “peak birth” period, when soldiers had returned home to their families. Supplies ran out. Gloves were gone.
“It means I have to use my bare hands […] Any time I remember it, I feel really emotional,” she said.
“You know exactly what you need to do to keep the mother and baby safe, but the environment does not allow you to meet those standards.”
Her account reflects a broader and deeply entrenched crisis across sub-Saharan Africa, where new research shows that basic conditions for safe childbirth remain out of reach for millions of women.
A report published recently by WaterAid found that one in nine women who give birth in the region will develop life-threatening maternal sepsis, a condition caused by infections linked to poor hygiene during pregnancy, childbirth or the months after delivery. The findings are drawn from an assessment of maternity wards across 10 countries in sub-Saharan Africa.
The numbers point to a systemic failure. More than three quarters of births in the region take place in facilities that lack basic sanitation. Researchers found that 65 percent of clinics did not have proper cleaning facilities. Two thirds lacked clean water or soap for staff to wash their hands. Nearly 80 percent had no functioning toilet.
Zambia recorded the highest rate of inadequate sanitation, with 98.8 percent of clinics affected, followed by Ghana and Malawi.
The problem extends beyond Africa. In six Asian countries studied, nearly two thirds of births also occurred in facilities without basic sanitation, underscoring the global nature of the challenge.
Maternal sepsis accounts for 11 percent of maternal deaths worldwide, contributing to an estimated 261,000 fatalities each year. The condition can stem from infections in surgical wounds after caesarean sections, untreated tears during childbirth, urinary tract infections or infections of the uterine lining.
Over the past four decades, global maternal mortality has declined significantly. But in Africa, progress has stalled. According to UNICEF, the number of women dying from childbirth-related complications has remained relatively constant, driven in part by population growth and a slowdown in health gains since 2016.
For many women, the absence of something as basic as water has reshaped decisions about where and how to give birth.
Clean water, Ms Yusuf said, is essential for sterilizing equipment, preparing delivery spaces and allowing women to clean themselves after childbirth. Yet in many rural clinics, patients or their relatives must fetch water themselves.
“Imagine a woman who is already in severe labour. The last thing she will want to think of is worrying about where the water is going to come from,” she said.
In such conditions, some women choose to avoid clinics altogether.
“Even though giving birth at home carries risk, many women still feel it is safer than going to a health facility where there is no water,” Ms Yusuf said.
The consequences of that calculation can be severe. Delivering at home without skilled care increases the likelihood of complications, including hemorrhage and infection, which are among the leading causes of maternal death.
The strain on maternity care is not confined to low-income countries. In Britain, maternal mortality has risen in recent years after decades of decline. Research from the National Perinatal Epidemiology Unit at the University of Oxford found that maternal deaths are now 20 percent higher than they were between 2009 and 2011, citing pressure on health services, staffing shortages, mental health challenges and persistent inequality.
WaterAid estimates that more than 3,800 women could be saved from sepsis each year across the 16 countries studied if healthcare facilities were equipped with clean water, adequate sanitation and basic hygiene infrastructure.
“Now is the moment for the UK government to re-establish its credibility as a global leader by committing new investment and placing women and girls at the heart of its future development strategy,” said Amaka Godfrey, the organization’s executive director of international programs.
“No woman, anywhere, should fear dying in childbirth simply because there is no clean water.”
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