Abstract
Every month of May, the international community commemorates the International Day of the Midwife (5th May), the International Day to End Obstetric Fistula (23rd May), and Menstrual Health/Hygiene Day (28th May) —three observances that collectively spotlight the urgent and interconnected realities of women’s and girls’ health. Yet for fragile and conflict-affected countries such as South Sudan, these commemorations risk becoming symbolic rituals unless matched by sustained political commitment and financing. South Sudan continues to experience one of the world’s highest burdens of preventable maternal mortality, adolescent pregnancy, obstetric fistula, unmet need for sexual and reproductive health services, and gender-based inequities in healthcare access. At the same time, the global health financing landscape is undergoing profound strain, with diminishing development assistance threatening decades of gains in reproductive, maternal, newborn, child, and adolescent health.
This advocacy review examines the state of maternal, newborn, and adolescent health (MNAH) in South Sudan through the lens of health systems fragility, humanitarian vulnerability, gender inequality, and declining global financing for sexual and reproductive health. The article argues that investments in midwifery, emergency obstetric and newborn care, obstetric fistula prevention and treatment, adolescent reproductive health, and menstrual health and hygiene are among the most cost-effective and transformative investments available to fragile states. The paper further calls for a paradigm shift from short-term humanitarian dependency toward sustainable domestic financing, innovative partnerships, development financing, and integrated resilience-building approaches. The article concludes that safeguarding the lives, dignity, and futures of women and girls in South Sudan is not only a humanitarian imperative but also a prerequisite for peacebuilding, economic recovery, gender equality, and national development.
Introduction
The month of May occupies a uniquely important place in the global calendar for women’s and girls’ health. The International Day of the Midwife on 5 May recognizes the indispensable role of midwives in preventing maternal and newborn deaths. The International Day to End Obstetric Fistula on 23 May draws global attention to one of the most devastating yet preventable childbirth injuries affecting women and girls in low-resource settings. Menstrual Hygiene Day on 28 May highlights the persistent inequalities and stigma surrounding menstrual health and dignity.
Together, these commemorations reflect a continuum of sexual and reproductive health and rights that extends from adolescence through pregnancy and childbirth to women’s dignity and lifelong wellbeing. They also expose the deep inequities that continue to characterize maternal and reproductive healthcare in fragile and conflict-affected settings such as South Sudan.
More than a decade after independence, South Sudan remains among the most dangerous places in the world to become pregnant or give birth. Years of conflict, displacement, economic instability, climate shocks, disease outbreaks, weak infrastructure, and chronic underinvestment in health systems have created severe barriers to accessing lifesaving maternal and reproductive health services. Women and girls—particularly those in rural and hard-to-reach communities—continue to bear a disproportionate burden of these systemic failures.
These challenges are unfolding at a time when global financing for maternal and reproductive health is becoming increasingly uncertain. International donor priorities are shifting amid competing global crises, geopolitical tensions, economic slowdowns, humanitarian emergencies, and reductions in overseas development assistance. Fragile states such as South Sudan, which remain heavily dependent on external support for health service delivery, face growing risks of financing gaps that could reverse already fragile gains in maternal and adolescent health outcomes.
This moment demands urgent collective action. The global community must move beyond annual commemorations and toward sustained investments capable of transforming the lives of women and girls. Without bold financing commitments and strengthened national ownership, the Sustainable Development Goals related to maternal health, gender equality, and universal health coverage will remain out of reach for South Sudan.
Maternal, Newborn and Adolescent Health in South Sudan: A Crisis of Equity and Survival
South Sudan continues to record one of the highest maternal mortality ratios globally. Thousands of women die every year from preventable causes related to pregnancy and childbirth, including postpartum haemorrhage, obstructed labour, sepsis, hypertensive disorders, and unsafe abortion. Many of these deaths occur because women are unable to access skilled birth attendants, emergency obstetric and newborn care, referral systems, blood transfusion services, or functioning health facilities.
The situation is particularly severe in remote and conflict-affected areas where health infrastructure is weak or non-existent. Long distances to health facilities, insecurity, flooding, poor roads, shortages of medicines and supplies, and limited transportation contribute to delays in seeking, reaching, and receiving care. In some communities, women in obstructed labour may travel for days before reaching a facility capable of performing a lifesaving caesarean section.
Newborn survival is equally precarious. Neonatal deaths remain high due to birth asphyxia, prematurity, infections, and inadequate newborn care. Preventable stillbirths continue to occur at alarming levels. The health and survival of mothers and newborns are inseparable; investments in one directly affect outcomes in the other.
Adolescents face additional vulnerabilities. Child marriage, early pregnancy, school dropout, gender-based violence, and limited access to comprehensive sexuality education continue to undermine the health and futures of adolescent girls. Adolescent pregnancies carry elevated risks of maternal death, obstetric complications, fistula, and neonatal mortality. Many girls enter motherhood before their bodies are physically mature, further perpetuating cycles of poverty, inequality, and poor health outcomes.
The burden of obstetric fistula in South Sudan represents one of the clearest manifestations of systemic neglect in maternal healthcare. Thousands of women and girls are estimated to be living with untreated fistula, often resulting from prolonged obstructed labour without timely medical intervention. Beyond the physical consequences of chronic incontinence, fistula survivors frequently experience stigma, social exclusion, psychological trauma, marital breakdown, and economic marginalization.
Menstrual health and hygiene challenges compound these inequities. Many girls and women lack access to affordable menstrual products, safe sanitation facilities, clean water, and accurate information about menstruation. Menstrual stigma contributes to school absenteeism, reduced participation in public life, and diminished dignity. In humanitarian settings, displaced women and girls often face even greater barriers to managing menstruation safely and privately.
Collectively, these indicators reflect not isolated health problems, but a broader crisis of gender inequality, social injustice, and underinvestment in human capital.
Midwifery as a High-Impact Investment
The International Day of the Midwife serves as an important reminder that midwives remain central to reducing maternal and newborn mortality. Evidence consistently demonstrates that a well-trained, adequately supported midwifery workforce can avert a substantial proportion of maternal and neonatal deaths and stillbirths.
Yet South Sudan faces a critical shortage of skilled midwives, particularly in rural and underserved areas. Existing midwifery training institutions often struggle with inadequate infrastructure, shortages of tutors and learning materials, and insufficient financing. Many health facilities operate without enough skilled personnel to provide basic emergency obstetric and newborn care.
Investing in midwifery is among the most cost-effective interventions available to South Sudan. Beyond improving survival outcomes, midwives provide a continuum of care that includes antenatal services, skilled birth attendance, postnatal care, family planning, sexual and reproductive health counselling, and referral for complications. Midwives are also critical frontline actors in humanitarian settings where access to healthcare is disrupted.
Scaling up midwifery education, deployment, retention, regulation, and professional support should therefore be treated as a national development priority rather than a peripheral health intervention. Strategic investments in midwifery strengthen health systems resilience while advancing universal health coverage and gender-responsive healthcare.
Obstetric Fistula: A Preventable Tragedy and Human Rights Concern
Obstetric fistula remains one of the starkest indicators of inequity in access to quality maternal healthcare. In high-income countries, fistula has become exceedingly rare due to universal access to timely obstetric care. In South Sudan, however, it continues to affect thousands of women and girls whose lives are often permanently altered by preventable childbirth injuries.
Ending obstetric fistula requires a dual approach focused on both prevention and treatment. Prevention depends on strengthening access to skilled birth attendance, emergency obstetric care, adolescent reproductive health services, nutrition, transportation, and timely referrals. It also requires addressing harmful social determinants such as child marriage, gender inequality, and poverty.
Treatment and reintegration services remain critically underfunded. Fistula repair surgery, psychosocial counselling, livelihood support, and community reintegration programmes are essential for restoring dignity and social inclusion to survivors. However, access to specialized fistula services remains limited and highly dependent on external donor support.
The International Day to End Obstetric Fistula should therefore serve not only as a day of awareness but also as an accountability platform for mobilizing investments in maternal healthcare systems capable of preventing fistula entirely.
Menstrual Health and Hygiene: Restoring Dignity and Opportunity
Menstrual health and hygiene have increasingly emerged as essential components of sexual and reproductive health and rights. Yet menstrual health remains underprioritized in many national health and education budgets.
In South Sudan, menstrual stigma, poverty, and inadequate sanitation infrastructure continue to affect girls’ educational participation, self-esteem, and wellbeing. Many adolescent girls miss school during menstruation due to lack of menstrual products, privacy, and supportive environments. In displacement settings, menstrual needs are frequently overlooked within humanitarian response mechanisms.
Investments in menstrual health yield benefits that extend beyond hygiene management. They contribute to educational attainment, gender equality, psychosocial wellbeing, and adolescent empowerment. Integrating menstrual health into school health programmes, humanitarian responses, reproductive health services, and gender policies should therefore become a core component of national development planning.
Shrinking Global Financing and the Risk of Reversal
Despite longstanding global commitments to women’s and girls’ health, financing for reproductive, maternal, newborn, and adolescent health remains insufficient. Fragile states such as South Sudan are especially vulnerable to fluctuations in donor priorities and development assistance.
Recent years have witnessed growing pressures on global health financing due to multiple concurrent crises, including armed conflicts, inflation, climate emergencies, debt distress, and economic instability. As donor countries face domestic fiscal constraints, development assistance for health is increasingly stretched across competing priorities.
For South Sudan, where external assistance supports a substantial proportion of health service delivery, reductions in donor funding pose serious risks. Cuts to sexual and reproductive health programmes can lead to shortages of lifesaving medicines, disruptions in midwifery services, reduced family planning access, closure of outreach programmes, and weakened emergency obstetric care.
The consequences of underinvestment are profound. Maternal deaths increase. Adolescent pregnancies rise. Fistula cases accumulate. Unsafe abortions become more common. Girls drop out of school. Families fall deeper into poverty. Health systems become less resilient to future crises.
The cost of inaction far exceeds the cost of investment.
Reimagining Financing for Maternal, Newborn and Adolescent Health
Addressing the maternal and reproductive health crisis in South Sudan requires a shift from fragmented, short-term approaches toward sustainable and integrated financing models.
First, domestic financing for health must increase substantially. Although South Sudan faces fiscal constraints, prioritizing maternal and reproductive health within national budgets is essential for long-term sustainability. Investments in women’s health should be recognized as investments in economic productivity, human capital, and national stability.
Second, innovative financing mechanisms should be explored. Partnerships with development banks, pooled financing mechanisms, private sector actors, philanthropic institutions, and global financing facilities can help diversify funding sources for maternal and adolescent health programmes.
Third, humanitarian and development financing must become better integrated. South Sudan’s health challenges cannot be addressed solely through emergency response frameworks. Long-term investments in health systems strengthening, workforce development, infrastructure, and resilience-building are equally critical.
Fourth, gender-responsive financing approaches should guide all investments. Budgeting processes should explicitly prioritize the health needs of women, girls, adolescents, and marginalized populations.
Finally, accountability mechanisms are needed to ensure that financing commitments translate into measurable outcomes for women and girls. Data systems, monitoring frameworks, and community engagement must be strengthened to track progress and ensure equitable access to services.
Conclusion: From Symbolic Observance to Sustained Investment
The commemorations observed each May should not remain symbolic annual events disconnected from policy action and financing commitments. For South Sudan, they should instead serve as global accountability milestones that compel governments, donors, development partners, financial institutions, and civil society to invest meaningfully in the health and dignity of women and girls.
From an expert perspective, maternal, newborn, and adolescent health is not merely a sectoral health issue; it is fundamentally linked to human rights, gender equality, peacebuilding, education, economic productivity, and sustainable development. Every preventable maternal death represents a collective failure of political will, health financing, and social justice.
The evidence is clear: investments in midwifery, emergency obstetric care, family planning, adolescent health, fistula prevention and treatment, and menstrual health are among the most impactful investments available to fragile states. These interventions save lives, strengthen resilience, reduce poverty, and expand opportunities for future generations.
At a time of shrinking global health financing, the response cannot be retreat. Instead, this moment demands renewed solidarity, innovative financing, stronger domestic ownership, and sustained global commitment.
Women and girls in South Sudan cannot afford another decade of underinvestment. The time to move from commemoration to commitment is now.
The writer, Dr Achu Lordfred, is Sexual and Reproductive Health Coordinator for UNFPA in Nigeria. The opinions and ideas presented in this article are those of the author and do not necessarily represent the views of his employer.
The views expressed in ‘opinion’ articles published by Radio Tamazuj are solely those of the writer. The veracity of any claims made is the responsibility of the author, not Radio Tamazuj.
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