BIRAO — Maternal health services in Birao, Central African Republic, collapsed in 2025 after the United States terminated funding to the U.N. Population Fund (UNFPA), leading to the closure of key clinics and the loss of dozens of health worker jobs in a conflict-affected region with already high maternal mortality rates. The district hospital in Birao, which serves approximately 70,000 residents and 22,000 Sudanese refugees, now operates with severe shortages of staff and medical supplies.
Four UNFPA-funded midwives in Birao, including Clara Abessendé, lost their positions following the U.S. funding cuts, and two U.S.-backed health facilities shut down. A former UNFPA-supported “safe space” that provided transport for pregnant women to the hospital also closed. UNFPA had been the sole supplier of reproductive health products in the area. Its country budget has since been halved to $6.5 million.
“The risk of maternal death is going to increase if there is no solution.” said Victor Rakoto, UNFPA country director. Marie Justine Mamba Ibingui, a UNFPA program officer, added, “Some women run the risk of dying in pregnancy situations that are not medically managed.”
Women in the Central African Republic face a maternal mortality ratio of 829 deaths per 100,000 births—40 times higher than in the United States—and over 40% of births occur outside medical facilities, according to United Nations estimates. The situation worsened after Sudan’s war began in early 2023, tripling the number of women seeking care in Birao. Hospital staff report running out of antibiotics and malaria treatments, and the maternity ward’s eight beds are often overcrowded.
Clara Abessendé, one of the dismissed midwives, said, “As a result, there were more cases of infant and maternal deaths.” She added, “The children born in my hands—I abandoned them like that,” expressing distress over her forced departure from the job.