GOMA, Congo — In the maternity ward in the east CongoIrene Nabudeba placed her hands on her bulging belly, worried about giving birth in the city. under rebel control.
The conflict that flared up this year has led to many medical supplies remaining behind the front lines. Infrastructure such as running water collapsed along with the economy in Gomahumanitarian and commercial center of the region.
And now the only glimmer of hope for mothers – a free maternity care program offered by the Congolese government – has disappeared after it was not renewed in June. It is unclear why and Congolese officials did not respond to questions.
Nabudeba has five children and wonders if the sixth will survive.
“In the hospital they ask us for money that we don’t have. I force myself to come for consultations, but for childbirth… I don’t know where I will find the money,” she said at the Afia Khimbi Medical Center.
Several women told The Associated Press they could not afford maternity care after Congo's program aimed at reducing one of the world's highest maternal and neonatal mortality rates ended earlier this year. The program, launched in 2023, offered free consultations and treatment for medical conditions and at-risk pregnant women at selected health facilities across the country.
Congo ranked second in the world in maternal deaths with 19,000 in 2023, behind Nigeria with 75,000 deaths, according to the UN.
Health workers say more women in Goma are now giving birth at home without skilled care, sometimes in unsanitary conditions, leaving them vulnerable to bleeding, infection or death.
Clinics and hospitals were already struggling after M23 rebels, backed by neighboring Rwanda, captured Goma in escalating fighting in January.
Although the clashes have subsided in the background Peace efforts led by the US and Qatar, In recent days, fighting has escalated again The conflict has destroyed government institutions, disrupted basic services and displaced more than 700,000 people, according to the UN humanitarian office.
Armed rebels can be seen everywhere in Goma, making a pregnant woman's visit to a clinic another source of concern.
Freddy Kaniki, M23's deputy coordinator, told the AP that free maternity support “wasn't renewed because it was a failure,” without elaborating. Congolese officials did not respond to questions.
Rwanda denies supporting the M23 movement, despite UN experts saying they have evidence of it. Rwanda is proud of its healthcare and recently signed a five-year agreement with the US to invest up to $158 million in its healthcare sector.
The destruction of basic services in rebel-controlled areas, coupled with massive population displacement and insecurity, has meant that civilians have struggled to access even basic health care.
An International Committee of the Red Cross assessment in September found that at least 85% of health facilities were experiencing drug shortages and nearly 40% were seeing an outflow of staff after conflict intensified in North and South Kivu provinces.
In October, the ICRC said 200 health facilities in eastern Congo had run out of medicine due to looting and supply disruptions. Doctors Without Borders (MSF) reported attacks on hospitals, blockades of ambulances, and threats or killings of medical staff.
Goma clinic births now cost between $5 and $10, according to the World Bank, unaffordable for many families in a region where more than 70% of the population lives on less than $2.15 a day.
Frank Ndachetere Kandoni, chief nurse at Afia Himbi Health Centre, said the number of births there under the free program jumped from about five a month to more than 20. But the program ended in June.
Looking at the statistics table in his office, Candoni said the number of births per month is now down to nine.
“When a parent cannot pay even 10,000 Congolese francs ($4.50) to care for his wife or child, it is a real problem,” the nurse said.
Meanwhile, banks in Goma closed, prices soared and the franc depreciated.
Nabudeba's husband, a driver, has been unemployed since January. She said her family is barely getting by.
“When the war broke out, we lost all our resources,” she said. “The situation has not been favorable lately and we are suffering a lot.”
Across town, at Rehem Health Centre, Ernestina Baleke waited with concern on her face for help during her ninth pregnancy. She said she didn't know where she would get the money for delivery.
She said her husband lost his job at the factory when the site was looted earlier in the conflict. Then their house burned down.
“I don’t even have 100 francs (45 cents) in my pocket,” Baleke said.
She walks more than half a mile to the hospital because she can't afford transportation. There are three months left before her due date.
“The authorities must restore free healthcare,” Baleke said. “We risk dying in our homes during childbirth.”
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