What’s frustrating about maternal deaths is that, in 2025, a lot of them are avoidable. Yet childbearers across the African continent continue to lose their lives to preventable pregnancy or childbirth complications.
The UN and its entities — including the World Health Organization (WHO) and UN Population Fund (UNFPA) — estimated, after studying the issue over 20 years, that 70% of the world’s maternal deaths occurred in sub-Saharan Africa, and a good number of them could have been prevented.
One African country that went against the grain of continental trends was Rwanda. For context, a maternal mortality rate (MMR) is calculated by looking at the number of deaths that occurred in comparison to live births in the same time frame. In an impressive feat, Rwanda managed to decrease its MMR from 1,007 maternal deaths per 100,000 live births in 2002 to 2259 deaths per 100,000 live births in 2020.
While several countries across the continent have struggled to curb the issue, the East African nation has managed to see the number of preventable deaths decrease dramatically over two decades. The question is: how? What is the country doing to protect the lives of childbearers from being lost?
1. Community Health Workers
Access to healthcare is a large reason for maternal or pregnancy deaths across the continent — and by access, we mean both physical access to medical facilities, as well as the ability to afford maternal healthcare. These deaths largely happen because healthcare is often not in reach to those who need it most, either due to distance, lack of infrastructure, or lack of financial resources.
Community health programs change that drastically by bringing access to maternal healthcare closer to home — and community health workers (CHW) are the backbone of these programs. Rwanda recognized the importance of community-based care in the early 2000s and initiated a program that trained and employed around 45,000 CHWs to provide maternal health services, including antenatal care, safe delivery support, and postnatal follow-up.
In fact, one of the biggest challenges in solving maternal deaths was post-partum blood loss, which accounted for a quarter of deaths reported prior to community initiatives. However, this massively decreased after CHWs were trained to handle them locally.
The country continues to invest in its local health practitioners, which is necessary as the rate of MMR decline in Rwanda has slowed over recent years — meaning the fight needs fresh solutions.
Enter the 4x4 Reform — the health ministry’s goal, announced in 2023, to quadruple its healthcare workforce in the next four years. This is a solution to Rwanda currently falling three skilled healthcare professionals short of the WHO’s recommended 4 professionals per 1,000 of the population.
2. Family Planning & National Investment in Midwives
Maternal deaths can happen as a result of low access to sex education and family planning, which leads to expectant parents not understanding the complications that can come with multiple pregnancies and childbirths per parent. Family planning and sexual and reproductive health education became a priority for Rwanda over the last two decades.
Through community health programs and skilled care workers, the country boosted access to contraceptives and education surrounding them significantly through community health programs, helping to lower the number of births per childbearer and, as a result, lowering the risks associated with frequent pregnancies.
Taking it one step further, the government has partnered with the UNFPA to focus on scaling the number of midwives across the country to support pregnancy and birthing needs. This partnership, which came off the back of the aforementioned 4x4 reform announcement, has seen the UNFPA provide scholarships to aspiring midwives, and has also brought in vital equipment such as birthing simulators to some of the country’s universities to support learning conditions.
3. Universal Healthcare
In 2004, Rwanda rolled out its community-based universal health scheme, officially allowing the country to take charge of its fight against maternal mortality. The affordability and accessibility of Rwanda's community-based health insurance is a major key to its success in fighting maternal deaths. It allowed childbearers, particularly those experiencing poverty or facing financial difficulty, to actively seek and access maternal healthcare that was not easily available to them previously.
It’s commendable that despite its massive successes, the country continues to tackle the issue as determinedly as it did over a decade ago, meaning that Rwanda has not lost steam in the fight. In fact, the country has an entire week dedicated to maternal and child healthcare which forms a landmark occasion every year.
While 259 deaths per 100,000 births is a triumph in comparison to what the country’s MMR used to be, it is still too high a statistic. It’s encouraging, however, that the country still sees innovative solutions introduced, and continues to reinvent itself in the fight against maternal mortality — making the nation a case study for its neighbours to refer to in their own battles against the phenomenon.