As South Sudan’s health sector reels from donor cuts and economic hardship, new research titled “Reasons and contributing factors for low health facility delivery in Bor, South Sudan” exposes gaps costing mothers’ lives and offers a roadmap for policymakers racing against time.
The groundbreaking study published in the South Sudan Medical Journal (SSMJ) has laid bare the stark reasons why most women in Bor town still give birth outside health facilities, even as the nation battles one of the world’s highest maternal mortality rates.
As its author, I strongly believe the August 2025 research comes at a critical juncture. South Sudan’s health sector is reeling from a 52% drop in donor funding for maternal health, and a senior ruling party official recently suggested rural communities could “rely on traditional medicine” amid hospital closures.
According to the study involving 70 women of reproductive age in Bor and surrounding villages, a staggering 60.3% of deliveries still take place outside health facilities, in homes or with traditional birth attendants. This persists despite South Sudan’s maternal mortality ratio hovering at 692 deaths per 100,000 live births, among the highest globally.
Three barriers killing mothers
Researchers identified a hierarchy of crises blocking women from reaching skilled care:
I. Distance and transport (65.8%) – The overwhelming majority of women cited inability to reach a facility due to long distances, poor roads, or lack of transport. With 60% of South Sudan’s roads inaccessible for half the year due to flooding, many women simply cannot make the journey.
II. Facility closures (21%) – One in five women who delivered outside a health facility reported arriving to find the hospital or clinic closed. This points to systemic failures in staffing, funding, and hours of operation, problems now worsening as facilities face shutdowns nationwide.
III. Financial constraints (13.2%) – Even where services are nominally free, transport costs, unofficial fees, and the need to feed family members during a facility stay remain prohibitive for many families.
The study found that 71.4% of women had no formal education, a factor strongly linked to lower health facility utilization. Yet significantly, only 11.4% cited cultural beliefs as a barrier, suggesting that infrastructure and access, not tradition, are the true culprits.
Suffice to say, the probability of delivering at a health facility increases with a higher level of education. There is therefore a need for collaboration among all stakeholders to reverse the trend urgently.
What women say they need
When asked what would encourage facility deliveries, respondents offered practical, low cost solutions that policymakers could implement immediately: better services, including medicines, food, and sanitation (27.1%); establishment of more health facilities near communities (15.7%); opening or rehabilitating roads (10.0%); employing and motivating more health workers (10.0%); and peace, security, and development (7.1%).
Notably, only 5.7% requested removal of delivery fees, suggesting that even where services are free, the hidden costs of transport, food, and quality care remain insurmountable.
A policy lifeline or a mirage?
At the National Health Summit in December 2025, the preceding health minister unveiled a Ministerial Initiative on Maternal and Newborn Health built on four pillars: saving lives, building climate resilient systems, advancing universal health coverage, and prioritizing equity for the hardest to reach.
The initiative explicitly promises mobile health units, flood resistant facilities, and free maternal services, all of which directly address the Bor study’s findings. The WHO has pledged technical support, and innovative pilots such as UNDP’s digital ambulance platform are being tested.
But those promises now face a brutal reality check.
Funding freefall
A February 2025 situation report from UNFPA revealed that South Sudan’s maternal health response has received only 14% of required funding, with the suspension of U.S. aid and broader donor reductions forcing cuts to essential services. Across ten sub Saharan African countries analyzed in March 2026, South Sudan and Uganda recorded the steepest donor declines at 52%.
Against this backdrop, comments by SPLM Secretary General Dr. Akol Paul Kordit suggesting rural communities could rely on traditional herbal remedies amid hospital closures have alarmed health experts.
According to the Bor study, women’s choice of health facility delivery relies partly on permission being granted by their partners, underscoring how economic pressure on households further erodes women’s access to care.
A roadmap for grassroots action
The Bor research offers clear priorities for community leaders and local policymakers even as national funding tightens:
I. Keep facilities open – Addressing the 21% closure rate requires no new money, only accountability, ensuring posted hours are honored and staff are present.
II. Food as medicine – Women explicitly requested feeding for patients. Modest nutrition support could dramatically increase facility stays.
III. Transport solutions – Community based emergency transport funds, bicycle ambulances, or partnerships with local boat owners in flood prone areas could bridge the distance gap.
IV. Health worker motivation – Training and retaining skilled birth attendants requires not just salaries but basic supplies and accommodations, investments that yield immediate returns in lives saved.
V. Leverage the willing – Crucially, 90% of respondents said they were willing to participate in awareness campaigns to promote facility delivery. Community health workers have a ready audience.
The bottom line
The Bor study is not an academic abstraction, it is a warning siren. Every percentage point of the 60.3% of non facility deliveries represents women bleeding out at home, infants dying from preventable infections, and families shattered by loss that could have been averted.
As some respondents put it simply: “Better services at health facilities”, including more medicines, food, sanitation, and respect, would bring them in.
For South Sudan’s policymakers, the choice is stark: heed the evidence from Bor and invest in the practical solutions women themselves have identified, or watch another generation of mothers die not from ignorance or tradition, but from systems that failed to reach them.
To this end, a call for collaboration among various stakeholders should be emphasized urgently. With funding collapsing and facilities closing, collaboration is no longer optional, it is the only path forward.
The writer, Manas James Okony, is a South Sudanese journalist with a background in public health. He can be reached via manasjokony@gmail.com.
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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