A nurse checks a pregnant woman. (Photo: WHO South Sudan).

JUBA, (Eye Radio) – South Sudan is at a defining moment in pursuit of fair access to healthcare, especially in maternal and child health where mortality rates remain “unacceptably high”, the World Health Organization (WHO) said, on the commemoration of World Health Day 2025.

According to WHO Representative to South Sudan, Dr. Humphrey Karamagi, the country still reports one of the highest maternal mortality ratios globally, with 1,223 maternal deaths for every 100,000 live births.

“Nowhere is the urgency more evident than in the area of maternal and newborn health, where mortality rates remain unacceptably high and progress is hindered by persistent system-level gaps,” Karamagi said in a press statement.

He added that in South Sudan, 40 babies die per 1,000 births while the country has a stillbirth rate of 26 per 1,000.

“These outcomes are driven by well-documented barriers such as limited access to skilled care, low rates of facility-based deliveries, insufficient emergency obstetric services, and underutilization of reproductive health interventions.”

Dr. Karamagi said skilled nurses and midwives are still scarce despite targeted investments, adding that only 19 percent of deliveries occur with a trained health worker, and just 3 percent of facilities are equipped to provide comprehensive emergency obstetric and newborn care.

He stated that caesarean section coverage accounts for only 1 percent of total expected births, which is far below the threshold needed to manage complications and prevent maternal and neonatal deaths.

“Although many women initiate care during pregnancy, far fewer complete the full continuum of essential services.”

Citing 2024 data from the District Health Information Software 2 (DHIS2), Dr. Karamagi said over 60 percent of pregnant women attended at least one antenatal care visit, but less than half completed four visits, and only 15 percent reached the World Health Organization-recommended eight contacts.

He said the decrease continues along the maternal care pathway with fewer than half of those who started antenatal care delivered in health facilities, and just one in four mothers and newborns received postnatal care within two days.

The UN health official however pointed out that women who delivered in health facilities were significantly more likely to receive timely postnatal care, highlighting the protective effect of institutional deliveries.

Encouragingly, he said, antenatal attendance is important for early newborn interventions, with babies born to women who attended to antenatal care receiving the BCG vaccine used to prevent Tuberculosis in children.

“These service-level challenges are closely linked to broader health system constraints. While policy frameworks are in place, implementation is sometimes slowed by coordination complexities across sectors.”

Dr. Karamagi said health financing continues to rely significantly on external support, highlighting the need to strengthen domestic resource mobilization.

He stated that gaps in the availability and distribution of skilled health workers, particularly midwives and obstetricians, remain a key concern, alongside periodic stock-outs of essential maternal and newborn commodities.

According to him, WHO is calling for a renewed collective focus on integrated maternal and newborn health by strengthening national capacity for skilled birth attendance, including training, deployment, and retention of midwives, improves coverage and supports safer deliveries.

Dr. Karamagi said expanding access to comprehensive emergency obstetric and neonatal care, alongside functional referral systems, increases the ability to manage complications.

“Improving the availability of maternal and newborn commodities and advancing the use of the health information system, particularly DHIS2, enables timely monitoring and more effective planning. Institutionalizing the Maternal and Perinatal Death Surveillance and Response system allows for routine review of deaths and contributes to quality improvement.”

“Additional investments in maternal nutrition, education, and gender equity support long-term outcomes. Increasing the availability and uptake of modern contraceptives helps reduce unintended and high-risk pregnancies and improves reproductive health.”