The shortage of midwives across Africa has reached a critical threshold, with the continent shouldering nearly half of a global deficit estimated at 980,000. In conflict zones from South Sudan to eastern Democratic Republic of Congo, the crisis is not merely a statistic — it is a daily fight for survival waged in darkened delivery rooms, where skilled professionals lack the most basic tools to stop a mother bleeding to death.
The human cost of a systemic failure
Basa Christine Samson remembers the women she could not save. Growing up in South Sudan, she watched friends and neighbours die in childbirth, a grim procession that drove her to train as a midwife. Today, she works at a facility run by the International Rescue Committee (IRC), and while the reward of a healthy mother and child remains profound, the obstacles are relentless.
“You’re looking at your patient, and you know you can’t provide her with the correct equipment,” she says. “Because of the funding shortages, we have faced challenges with supplies. There are insufficient medical supplies and medications. We don’t have catheters; we don’t have sterile gloves. Sometimes the lights go out when there is no fuel, and we work in darkness and use torches.”
Her experience is far from isolated. The 2025 State of the World’s Midwifery Report for East and Southern Africa shows a modest improvement — rising from 2.5 to 3.2 midwives per 10,000 population — yet this remains well short of the global average of 4.4. Africa is home to 19 per cent of the world’s women of reproductive age but carries 46 per cent of the global midwife shortage.
“The gains are too modest and fragile,” says Shatha Elnakib, assistant research professor at Johns Hopkins Bloomberg School of Public Health. “We really need to accelerate progress.”
Conflict detonates an existing crisis
In war-torn regions — South Sudan, Sudan, Mali, Burkina Faso, and parts of eastern DRC — the shortage becomes catastrophic. Dr Caroline Tatua, Regional Health Lead at the IRC, puts it bluntly: “Conflict zones sit at the extreme end of a shortage that’s already severe continent-wide. It detonates an existing one.”
Viola Kiden, a midwife in South Sudan for three years, describes the nightmare logistics. “Insecurity is a big challenge. Sometimes the mothers don’t come early enough because movement at night is difficult, and by the time they arrive they have complications or are in an advanced stage and we have to try to manage and save them.”
Dr Tatua paints a vivid picture of a typical shift: roads too dangerous for referrals, power failing mid-delivery, no oxygen, no uterotonics to stop postpartum haemorrhage, patients arriving only when they are already dying. The midwife works alone, with no colleague to consult, no one to debrief with when a mother or baby is lost.
“Those are the words that come up again and again when you talk to midwives working in conflict-affected areas,” Dr Tatua says. “Overwhelmed, isolated, and under supported. And underneath the exhaustion, there’s real frustration. Midwives are highly skilled providers. But many feel invisible — sidelined by policy, without the formal recognition their clinical judgment actually deserves.”
A profession under siege
The erosion of the workforce is driven by a cascade of systemic failures. Healthcare facilities have been attacked and destroyed. Midwives have been specifically targeted — kidnapped as a military strategy. Thousands have been displaced, unable to practise in their home countries. Insecurity blocks new deployments. International funding cuts have severed supply chains for training, salaries, and essential commodities.
Even where facilities stand, the working conditions drive attrition. Low pay. Burnout. Absence of professional support. No career progression. Enos Walela, a nurse midwife operating a mobile clinic in Kenya’s Kakuma Refugee Camp, puts the supply crisis in stark terms: “There was a time we were out of drugs for postpartum haemorrhage for almost a week. We need adequate staffing and we need to make sure we have enough resources, especially supplies and emergency obstetric and newborn care medicines.”
Pathways to retention and resilience
Elnakib argues that governments must strengthen employment pathways, fix broken deployment systems, and offer financial and security incentives for service in conflict-affected areas. “Midwives need better salaries, hazard pay, security escorts, safe accommodation, better lighting and fencing around facilities, improved working conditions, and systematic mental health support rather than ad hoc or one-off interventions,” she says.
Dr Tatua agrees that security is the prerequisite: “Without adequate security and safe access, nothing else matters.” She points to community-based models — mobile clinics, outreach teams — that bring care to displaced populations rather than expecting women to navigate bombed roads to reach facilities that may no longer exist.
Local governments, NGOs, and communities must collaborate to guarantee that safety, she insists. The alternative is a deepening spiral: midwives continue to leave, the workforce shrinks, and women and babies die from causes that are entirely preventable.
Why it Matters
This crisis extends far beyond the delivery rooms of Juba, Goma, or Kakuma. The moral argument is unambiguous: no mother or newborn should die because a skilled pair of hands lacked a sterile glove, a functioning light, or a dose of oxytocin. But there is also a pragmatic reality that the world ignores at its peril. Health systems are interconnected; instability in one region reverberates globally through migration, disease spread, and economic disruption. Investing in Africa’s midwifery workforce — training, protecting, and retaining these professionals — is not charity. It is a strategic imperative for global health security, and a test of whether the international community values the lives of African women and children as equal to any others.
