By: Meadow Lavoie
Director of Research & Communications & Co-Founder
Maternal mortality is a devastating reality for far too many women in South Sudan, the world’s youngest country, which gained independence on July 9, 2011. South Sudan ranks among the lowest globally in terms of healthcare infrastructure. Only 26% of South Sudanese people live within an hour’s walk of a healthcare facility. The Juba Teaching Hospital, located in the capital, is the only referral hospital in the entire country. In 2021, 789 women died per 100,000 live births (WHO, 2021). Combined with limited access to contraceptives and minimal sexual education, pregnancy and childbirth become incredibly dangerous for South Sudanese women.
Leading Causes of Maternal Mortality in South Sudan Maternal deaths can occur at any stage of pregnancy and for a variety of reasons.
The most common causes include:
- Postpartum hemorrhage
- Sepsis
- Hypertensive disorders (e.g., eclampsia)
- HIV/AIDS
- Tuberculosis
- Prolonged or obstructed labor
- Lack of access to Caesarean sections
- Gender-based violence
Postpartum Hemorrhage, Pre-eclampsia, and Eclampsia
One of the most frequent causes of maternal death during labor is postpartum hemorrhage. This occurs when the uterus fails to contract adequately, preventing compression of bleeding blood vessels. Severe blood loss can result, leading to maternal death—and in cases where the umbilical cord remains attached, potentially the death of the child as well. Hemorrhaging can be worsened by preexisting conditions such as pre-eclampsia.
Pre-eclampsia is a hypertensive disorder that develops during pregnancy, characterized by high blood pressure and elevated protein levels in urine—an indicator of kidney failure (Mayo Clinic, 2022). Ideally, a pregnant person with pre-eclampsia would be placed on bed rest and advised to deliver early. In South Sudan, however, this is rarely feasible. With healthcare facilities often hours away, bed rest is not an option. Early delivery without access to proper medications and surgical equipment is both dangerous and nearly impossible. Black women are among the groups most likely to experience pre-eclampsia (Gray & McIntyre, n.d.).
Eclampsia is a severe complication of untreated pre-eclampsia, leading to seizures or coma. Even if survived, it can result in acute brain damage. South Sudan’s inadequate medical infrastructure makes these conditions far more lethal than in more resourced regions. Cultural norms also hinder essential practices like blood donation. Even when hemorrhaging is controlled, the lack of donated blood poses a significant risk of death.
Sepsis, HIV/AIDS, and Tuberculosis
South Sudan has a high HIV prevalence, with at least 2.4% of the population affected (Africa Press, 2025). Due to limited healthcare access and stigma surrounding sexual health, actual rates may be higher. Pregnancy while living with HIV/AIDS carries risks such as spontaneous abortion, stillbirth, perinatal death, and infant mortality. HIV can be transmitted from mother to child during pregnancy and breastfeeding (HIVinfo, 2025).
Tuberculosis (TB), a serious infection common across the continent, primarily affects the lungs. It is closely linked to HIV, as TB is an opportunistic infection that often targets immunocompromised individuals. People with HIV are 16 times more likely to develop TB, and many South Sudanese living with HIV also suffer from TB (CDC, 2025).
These conditions are exacerbated by poor access to treatment and antibacterialproducts. TB is a leading cause of death in South Sudan and presents additional risks during pregnancy, including miscarriage, stillbirth, and low birth weight. If untreated, TB can be passed from mother to child during pregnancy.
Pregnant individuals with HIV/AIDS or TB are also more susceptible to sepsis—alife-threatening condition where the body attacks itself in response to infection. Sepsis can lead to organ failure and death (End Sepsis, n.d.). Other infections that may cause sepsis during pregnancy include urinary tract infections, bacterial vaginosis (e.g., E.coli), and pneumonia.
Prolonged Labor, Obstructed Birth, and Cesarean Sections
Even when a South Sudanese woman carries a healthy pregnancy to term, labor complications remain a serious concern. Prolonged or obstructed labor often requires surgical intervention, but access to Caesarean sections is extremely limited.
“Prolonged obstructed labour accounts for 3% of severe childbirth-related complications. In South Sudan, there is an estimated backlog of 60,000 cases awaiting surgical repair, with fewer than 1,000 having received treatment.” —UNFPA
These complications are more common among adolescent mothers. SouthSudan’s adolescent birth rate is 158 per 1,000 (UNFPA South Sudan, n.d.). Obstructed labor can result in hemorrhaging, fistulas, and severe infections for the mother, and asphyxia or stillbirth for the child.
Cesarean sections account for less than 8% of births in South Sudan—not due to lack of need, but due to lack of access. Rates have increased in the Juba region, but timely access remains a major challenge.
“When patients are referred from other facilities… they often arrive too late and they may die before we can save them. Without good roads or vehicles,transportation is a major challenge, which means that some patients in need don’t even make it.” —Moyo, Doctors Without Borders (2018)
Improving maternal outcomes in South Sudan requires expanding access to surgical care and healthcare facilities.
Gender-Based Violence
In addition to medical challenges, many South Sudanese women facegender-based violence, which often intensifies during pregnancy. At least 50% of womenin South Sudan have experienced intimate partner violence (UNICEF, 2025). Pregnancycan become a death sentence, especially when it results from rape—stripping young girlsof autonomy and placing them in medical crisis (Ryeng, 2021).
Final Thoughts
The maternal mortality crisis is one of the most urgent issues facing SouthSudan’s healthcare system and society. It intersects with broader cultural challenges,including HIV, TB, and gender-based violence, and must be prioritized by the SouthSudanese government and healthcare providers. Organizations like Equip for Hope inSouth Sudan are working to combat this crisis by providing maternal care, sexualeducation, and access to contraceptives.
References
Africa Press. (2025, June 05). HIV prevalence drops 1% in WES, region still has highestin South Sudan. African Press. Retrieved July 13, 2025, from https://www.africa-press.net/south-sudan/all-news/hiv-prevalence-drops-1-in-wes-region-still-has-highest-in-south-sudan
CDC. (2023, May 23). Global HIV & Tuberculosis. Centers for Disease Control andPrevention.CDC. (2025, April 17). Tuberculosis in Pregnancy | Tuberculosis (TB).
CDC. RetrievedJuly 13, 2025, from https://www.cdc.gov/tb/about/pregnancy.html
DeVires, N. (2017, November 09). Making childbirth safer in South Sudan | UNICEF.Unicef. Retrieved July 13, 2025, from https://www.unicef.org/stories/making-childbirth-safer-south-sudan
End Sepsis. (n.d.). Maternal Sepsis. End Sepsis. Retrieved July 13, 2025, from https://www.endsepsis.org/what-is-sepsis/maternal-sepsis/
Gray, G., & McIntyre, J. (n.d.). HIV and pregnancy. HIV and pregnancy – PMC.Retrieved July 13, 2025, from https://pmc.ncbi.nlm.nih.gov/articles/PMC1865425/
HealthNet TPO. (2023, February 07). Investigating Maternal Mortality to Save Livesin South Sudan. Relief Web. Retrieved July 13, 2025, from https://reliefweb.int/report/south-sudan/investigating-maternal-mortality-save-lives-south-sudan
HIVinfo. (2025, April 14). HIV and Tuberculosis (TB) | NIH. HIVinfo. Retrieved July13, 2025, from https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-tuberculosis-tb
Mayo Clinic. (2022, April 15). Preeclampsia-Preeclampsia – Symptoms & causes. MayoClinic. Retrieved July 13, 2025, from https://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745
Ministry of Health South Sudan. (2020). South Sudan Health Sector HIV/AIDS Strategic Plan. Link to document
Mayo, M. (2018, December 18). South Sudan: “The most challenging thing for patientsis the difficulty of accessing maternal health services”.
Doctors Without Borders.Retrieved August 19, 2025, from https://www.doctorswithoutborders.org/latest/south-sudan-most-challenging-thing-patients-difficulty-accessing-maternal-health-services
National AIDS Commission South Sudan. (2021). South Sudan HIV/AIDS Strategic Plan 2021–2025. Link to PDFPEPFAR. (2023).
PEPFAR South Sudan Country Operational Plan. U.S. Department of State.
Republic of South Sudan. (2024, January 15). Weekly Integrated Disease Surveillanceand Response (IDSR) Epidemiological Bulletin.
WHO Africa. Retrieved July 13,2025, from https://www.afro.who.int/sites/default/files/2024-02/South%20Sudan%20IDSR%20Weekly%20Bulletin%20Week%2003,%2015-21%20January%202024.pdf
Ryeng, H. S. (2021, March 25). Making strong stronger How UNICEF is fighting Gender-based violence in South Sudan.
UNICEF. Retrieved August 19, 2025, from https://www.unicef.org/southsudan/stories/making-strong-stronger
South Sudan | World Bank Gender Data Portal. (n.d.). Gender Data Portal. RetrievedJuly 13, 2025, from https://genderdata.worldbank.org/en/economies/south-sudan
UNAIDS. (2022). Global HIV & AIDS statistics — Fact sheet. UNAIDS.
UNICEF South Sudan. (2022, December 1). World AIDS Day 2022: Equalize. UNICEF.UNFPA. (n.d.). HIV Prevention and Response. UNFPA South Sudan. Retrieved July 13,2025, from https://southsudan.unfpa.org/en/topics/hiv-prevention-and-response UNFPA South Sudan. (n.d.). Obstetric Fistula.
UNFPA South Sudan. Retrieved August19, 2025, from https://southsudan.unfpa.org/en/topics/obstetric-fistula
WHO. (2021). HIV/AIDS. World Health Organization.