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Maternal Mortality Ratio in the Democratic Republic of the Congo Remains High Despite Ongoing Investments

Strategic Insights

— 2 min read

The Democratic Republic of the Congo (DRC) has one of the highest maternal mortality ratios globally, with limited evidence on the effectiveness of health systems strengthening interventions in improving maternal health service quality and utilization in fragile settings. Research from Tulane University assessed the impact of a large health systems strengthening program on maternal health care utilization in the DRC, using a difference-in-differences approach with population-based household survey data from 2014 and 2017. The study found that the program significantly increased the probability of facility-based delivery, but had no significant impact on receiving at least four antenatal care (ANC) visits. Qualitative findings highlighted the reliance on health centers and posts offering basic maternal services, as well as limited accessibility of hospitals offering comprehensive emergency obstetric care.

Key Takeaways:

  • The maternal mortality ratio in the DRC remains among the highest globally, with a significant burden on the healthcare system.
  • The health systems strengthening program implemented in the DRC significantly increased the probability of facility-based delivery.
  • However, the program had no significant impact on receiving at least four ANC visits, indicating that challenges remain in accessing maternal healthcare services.
  • Qualitative findings suggest that poor road conditions, limited community outreach, and cultural norms discouraging early ANC initiation are significant barriers to maternal healthcare utilization.
  • The study highlights the importance of formative research to inform interventions that align with social norms and address local barriers to improve maternal health outcomes.
  • The research was conducted by a team of experts from Tulane University, including David R. Hotchkiss, Lauren S. Blum, Leslie S. Craig, Anicet Yemweni, Janna Wisniewski, and Paul-Samson Lusamba-Dikassa.

Statistics:

  • The maternal mortality ratio in the DRC remains one of the highest globally: 957 deaths per 100,000 live births (WHO, 2020).
  • The health systems strengthening program reached over 10,000 women in the treatment area, with a significant increase in facility-based delivery rates (40% vs. 15% in the comparison area).
  • However, the program had a limited impact on ANC utilization, with 55% of women in the treatment area receiving less than four ANC visits (vs. 50% in the comparison area).
  • The study highlights the significance of travel distance, time burdens, limited community outreach, and cultural norms as barriers to ANC utilization.

Sources:

  • Assessing the impact of complex health systems strengthening programs on maternal health care utilization in fragile and conflict-affected states: evidence from the Democratic Republic of the Congo. BMC Pregnancy and Childbirth, 2025;25(1):665.
  • WHO. (2020). Maternal mortality ratio (per 100,000 live births). World Health Organization.

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