A Policy Paper on Improving Maternal, Newborn and Child Health Outcomes
Executive Summary
Let's look at some of the most severe maternal and child health challenges in the world. Tragically, women and children are still facing preventable deaths due to a mix of factors like limited access to quality healthcare, ongoing conflict, displacement, poverty, poor infrastructure, a shortage of skilled health workers, and weak referral systems.
As per the report from the World Health Organisation in 2025, South Sudan's maternal mortality ratio stood at around 1,223 deaths for every 100,000 live births. The situation for newborns and children is equally alarming, with mortality rates remaining alarmingly high. A significant number of births occur without the assistance of trained health professionals, and many health facilities are lacking in comprehensive emergency obstetric and newborn care.
This policy paper examines the various barriers that hinder access to antenatal care, skilled birth attendance, emergency obstetric services, immunisation, nutrition, and postnatal care. It advocates for a community-based, government-led approach that aligns with national health priorities. The key takeaway is that simply building more facilities isn't enough to reduce maternal and child deaths. We need reliable funding, trained personnel, access to essential medicines, community trust, empowering women in decision-making, effective referral systems, and accountability to truly make a difference.
Introduction
Maternal, newborn, and child health is significant for the overall development of a nation. When mothers come through pregnancy and childbirth safely, and children get the healthcare they need, families become more stable, kids are more likely to go to school, and communities grow stronger.
In South Sudan, though, many families encounter significant hurdles when trying to access healthcare. Ongoing conflict and insecurity disrupt services, while issues like flooding, displacement, and poor road conditions make it tough to reach health facilities. For some households, poverty makes it hard to afford transport, medicines, or other necessary expenses. Additionally, health facilities often struggle with inadequate staff, equipment, electricity, clean water, and emergency supplies.
This situation is particularly alarming because many maternal and newborn deaths could be avoided with timely and affordable interventions. Antenatal care can help spot complications during pregnancy. Having skilled professionals at births can lower risks during delivery. Postnatal care is essential for identifying infections, bleeding, and warning signs in newborns. Plus, immunization, breastfeeding support, nutrition services, and treatment for childhood illnesses can significantly boost survival rates.
The Scale of the Crisis
The situation surrounding maternal and newborn health in South Sudan is quite alarming. According to the WHO, only about 19 percent of deliveries are attended by trained health professionals, and a mere 3 percent of healthcare facilities are equipped to provide comprehensive emergency obstetric and newborn care. When it comes to caesarean sections, the coverage is shockingly low, sitting at around 1 percent of the expected births.
Antenatal care is also falling short. The WHO noted that while over 60 percent of pregnant women made at least one antenatal visit in 2024, less than half completed the recommended four visits, and only about 15 percent managed to reach the ideal eight contacts. Postnatal care is similarly lacking, with only about one in four mothers and their newborns receiving care within two days after birth.
These statistics paint a grim picture of the healthcare system's failure to provide continuous care. A woman might start her pregnancy care journey but may not return due to factors like distance, insecurity, costs, poor treatment, or lack of transportation. As a result, she could end up delivering at home without any skilled help and miss out on essential postnatal monitoring. This, in turn, means her newborn might miss critical early vaccinations, breastfeeding support, and screenings for any warning signs.
Key Drivers of Maternal and Child Mortality
Conflict and Displacement
When conflict erupts, it wreaks havoc on health infrastructure, uproots families, and hampers the movement of both health workers and patients. For pregnant women, this can mean being cut off from essential care during emergencies. Displacement camps and remote areas often lack the necessary maternity services, clean water, sanitation, and nutritional support.
The influx of refugees and returnees from neighboring Sudan has only added to the strain on already stretched resources. Humanitarian crises can also shift funding and political focus away from the crucial long-term development of health systems. Research into South Sudan’s health policy landscape has shown that ongoing conflict, disease outbreaks, flooding, and competing national priorities have all contributed to a decline in sustained investment in maternal and newborn health.
Geographic Isolation and Inadequate Infrastructure
In many areas, communities find themselves far away from hospitals, often facing long journeys on poorly maintained roads. When the rainy season hits, these roads can become nearly impossible to navigate, which can lead to dangerous delays for women dealing with obstructed labor, severe bleeding, eclampsia, or other serious complications.
A truly effective health system needs to encompass more than just medical facilities; it must also ensure access to transportation, communication, electricity, clean water, blood supplies, and dependable referral systems.
Shortages of healthcare professionals
The distribution of midwives, nurses, doctors, lab technicians, and community health workers is often quite uneven. Rural healthcare facilities frequently struggle to attract and keep qualified staff. Many health workers face challenges like low pay, inadequate housing, safety concerns, overwhelming workloads, and limited chances for professional growth.
While training more healthcare professionals is crucial, keeping them in their positions is just as important. It's essential that staff enjoy fair working conditions, receive proper supervision, have access to protective gear, and are offered opportunities for ongoing education.
Poverty and Household Decision-Making
When families face economic struggles, it can really impact their ability to get timely medical care. Costs for transportation, shortages of medicine, and unexpected expenses can all lead to delays in treatment. In some areas, women might also find themselves with limited power to decide when and where to seek healthcare.
To truly improve maternal health, it’s essential to involve husbands, elders, traditional leaders, women’s organisations, and community groups. Women need support to make informed choices about antenatal care, delivery, contraception, and emergency treatment.
Strengthening Antenatal Care
Antenatal care should be easy to access, respectful, and ongoing. It’s a crucial time to spot issues like anemia, hypertension, infections, malnutrition, high-risk pregnancies, and other complications.
South Sudan should work on expanding antenatal services through primary healthcare facilities, mobile clinics, and community outreach. The services offered should include:
• Early registration of pregnancy.
• Blood pressure and anemia screening.
• Testing for HIV, malaria, and other relevant conditions.
• Tetanus vaccinations.
• Nutrition counseling and iron-folic acid supplementation.
• Planning for birth and emergencies.
• Guidance on recognising danger signs and referral options.
• Screening for violence, psychological distress, and protection concerns.
To effectively communicate health messages, it's significant to use local languages and trusted community channels. Outreach services play a vital role in connecting with women who may live far from healthcare facilities or face challenges like insecurity and transportation issues.
Promoting Skilled Birth Attendance
Every woman deserves the chance to give birth with the support of a trained and skilled health professional. Having skilled birth attendance is particularly important because complications can arise quickly, sometimes requiring medications, surgery, blood transfusions, or even newborn resuscitation.
Policy priorities should focus on expanding midwifery training, sending staff to underserved areas, and enhancing maternity wards. It's essential for facilities to keep necessary supplies, infection-prevention materials, safe water, electricity, and newborn resuscitation equipment readily available.
Moreover, respectful maternity care is a must. Women should never have to endure verbal abuse, discrimination, unnecessary delays, or breaches of privacy. Creating a respectful environment can foster trust and motivate women to seek out health facilities when they need them.
Emergency Obstetric and Newborn Care
Ensuring the survival of mothers and newborns hinges on our ability to act swiftly in the face of complications. South Sudan needs to enhance both basic and comprehensive emergency obstetric and newborn care at key facilities.
Here are some priority interventions to focus on:
• Quick management of severe bleeding.
• Effective treatment for eclampsia and severe hypertension.
• Safe handling of obstructed labor.
• Capacity for performing caesarean sections when necessary.
• Access to blood transfusion services.
• Newborn resuscitation techniques.
• Prevention and treatment of neonatal infections.
• Specialised care for premature and low-birth-weight infants.
• Reliable ambulance and referral systems.
It’s important that referral protocols clearly outline which facilities are equipped to handle specific emergencies. We also need to enhance communication among community health workers, clinics, ambulances, and hospitals to ensure that referrals happen without unnecessary delays.
The moments right after birth are incredibly important. It's essential for mothers to be monitored for any signs of bleeding, infection, high blood pressure, depression, and other potential complications. Newborns, on the other hand, need help staying warm, getting the hang of breastfeeding, preventing infections, and recognizing any warning signs that might arise.
Postnatal care should kick in within 24 to 48 hours after delivery and continue with follow-up visits during those crucial first weeks. Community health workers play a vital role here, offering home visits, breastfeeding support, reminders for immunisations, and referrals for any newborns that may be unwell.
For children to thrive, routine immunisations, proper nutrition, malaria prevention, access to clean water, sanitation, and quick treatment for common illnesses like diarrhea and pneumonia are all key. It’s important that maternal and child health services work together seamlessly instead of being offered through separate, disconnected programs.
Nutrition and Social Protection
Malnutrition poses significant risks for pregnant women, newborns, and young children. It's crucial for expectant mothers to have access to nutritious food, essential micronutrients, and proper counseling. Infants should be supported with early and exclusive breastfeeding whenever it's medically suitable.
Nutrition services need to be integrated with antenatal care, immunisation, growth monitoring, and community outreach efforts. Families grappling with severe food insecurity might also benefit from social protection measures, cash assistance, food support, or livelihood programs.
Relying solely on health interventions won't address all the challenges posed by poverty. We need a comprehensive approach that brings together health, education, agriculture, water and sanitation, protection, and humanitarian agencies.
Financing, Governance and Accountability
Research shows that South Sudan has established important health policies and legal frameworks, but the execution is hampered by insufficient funding, disjointed programs, supply shortages, and a lack of accountability.
The government really needs to step up its game by boosting domestic investment in health and ensuring that budgets are executed effectively. While donor support is still crucial, it’s essential that external funding helps to strengthen our national systems instead of creating temporary structures that vanish once the projects wrap up.
We should establish a national maternal and child health financing framework that pinpoints clear, measurable priorities, such as:
• The number of operational maternity facilities.
• The availability of midwives and essential medications.
• The percentage of births that are attended by skilled professionals.
• Coverage for antenatal and postnatal care.
• Response times for emergency referrals.
• Reviews of maternal and perinatal deaths.
• Indicators for immunization and nutrition.
It’s vital to institutionalise Maternal and Perinatal Death Surveillance and Response. Every preventable death deserves a thorough, respectful review to uncover system failures and implement practical solutions.
Policy Recommendations
The Government of South Sudan, along with its partners, should take the following steps:
1. Prioritise maternal, newborn, and child health as a key national health focus.
2. Boost public funding for primary healthcare and emergency services.
3. Enhance antenatal, delivery, and postnatal care by offering both fixed and mobile services.
4. Train, deploy, and retain a greater number of midwives, nurses, and community health workers.
5. Elevate the quality of emergency obstetric and newborn care at referral hospitals.
6. Set up dependable ambulance, communication, and referral systems.
7. Ensure a steady supply of essential medicines, vaccines, blood, and equipment.
8. Strengthen immunisation, nutrition, malaria prevention, and WASH programs.
9. Encourage respectful maternity care and promote women’s involvement in health-related decisions.
10. Integrate maternal and child health initiatives into humanitarian and displacement responses.
11. Enhance health data collection, transparency, and public accountability.
12. Support community-driven research and encourage local participation in program design.
Conclusion
In South Sudan, ensuring the safety of mothers and babies is not just a matter of public health; it’s a vital part of the nation’s development agenda. The alarming mortality rates in the country stem from a mix of conflict, poverty, geographic isolation, inadequate infrastructure, limited funding, and significant gaps in essential services.
However, there is hope for progress when government bodies, communities, healthcare workers, humanitarian organisations, and development partners come together under a unified national framework. The key to success lies not in isolated projects but in a continuous, comprehensive approach to care—covering everything from pregnancy and safe deliveries to postnatal support, immunisations, nutrition, and early childhood healthcare.
South Sudan needs to shift from merely responding to emergencies to building resilient, accessible, and accountable health systems. Every mother deserves to give birth safely, and every child should have the chance to survive and flourish.
Caring for mothers and babies goes beyond medical duties; it’s a national pledge to uphold dignity, promote equality, and secure a brighter future for South Sudan.
Editorial and Research Disclaimer
This policy paper is designed to educate the public, spark policy discussions, and encourage further research. Keep in mind that statistics can differ based on the source, year, and methodology, so it's important to check them against the most recent official national datasets before using them in any formal academic, governmental, or funding documents. Additionally, this paper is not a substitute for personalised medical advice and should not replace consultations with qualified healthcare professionals.
