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Kirstie Allen
Medical Anthropology 272
June 11
th
, 2014
Maternal Mortality in South Sudan;
The Biggest Threat to a Womens Life
South Sudan recently became an independent country as of January 2011 and it faces
many daunting task to improve their health care system. Due to the country being one of the
poorest countries in the world, maternal mortality is at an astonishing high rate and a major
concern with most women living within this country. Maternal mortality is defined as the death
of a woman during pregnancy or shortly after pregnancy due to direct or indirect causes (2011
Rai and Ramadhan). In South Sudan, there are numerous reasons why maternal death is at a
high. Such reasons include, poor prenatal and maternal health, a lack of education about
reproductive health care, poor nutrition among the general population, and minimum access to
health care services throughout the nation. Governmental and nongovernmental organizations
have targeted these issues and are focusing on decreasing the maternal mortality rate by
improving the maternal health care structure in South Sudan (2012 World Bank).
South Sudan is located in southeast Africa with a total population estimated to be about
10.84 million people nationwide. South Sudan has a life expectancy to be around sixty-two of
age on average. The maternal mortality ratio (MMR) is measured by the number of maternal
deaths per 100,000 live births per year. Maternal mortality is often used as an alternative
measure for the quality of a countrys health care system, a measure of development, and an
indicator of economic and gender equality and health equity (2012 World Bank). As of 2010,
the maternal mortality rate in South Sudan is at an astonishing high of 2,054 maternal deaths per
100,000 live births. While in the United States, the maternal mortality rate is 21 maternal deaths
per 100,000 live births to put in perspective. It is on average that one in every seven women
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will die during pregnancy or at childbirth in South Sudan (2010 Foreman and Hogan 1610-
1612). Increasingly, the state of pregnancy has been medicalized, especially in the United States.
Many pregnant women are urged to seek care from a doctor or a health care professional
numerous times throughout pregnancy that includes scheduled blood tests, ultrasounds and
physical checkups. Ideally, pregnant women become advocacy to the westernized traditional
pregnancy, which gives women a natural state of mind that pregnancy should be monitored bio-
medically. The westernized traditional thought of pregnancy in the United States and other
developed countries, believe in the use medicalization by technologization and biomedical
procurers during childbirth. Underdeveloped countries such as South Sudan lack this option due
to several of reasons that gives South Sudan a high increase of women suffering from maternal
mortality.
South Sudan suffers from the lack of westernized medicine and biomedical care that is
commonly needed during pregnancy for a safe and health delivery. With South Sudan being one
of the poorest countries in the world, the shortage of health care facilities is a main reason why
many women are not receiving the attention needed during pregnancy or childbirth. The lack of
healthcare facilities is frequently due to the lack of funds that this country needs, which is
making this an economic issue as well. With a weak and underdeveloped economic system in
this country, it is very difficult to be able to supply biomedical care and/or westernized medical
attention needed to support women during pregnancy (2012 Green 1578).
Also, because of South Sudan being one of the poorest counties in the world, most
villages in this country lack any sort of transportation. Minimal access to healthcare services
from either being too far in distance to travel or no adequate transportation services to reach
these health services, are both major issues on why maternal mortality is at a high. This is
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commonly due from the minimum resources for vehicles and the rural areas in this country
having many unpaved roads for easy travel. With its predominantly rural population, at least
90% of births occur far from urban centers where clinics are based. Most often, women use
anything available - from bicycles to donkeys, being carried on a stretcher to hitching a lift in car
- to get to a clinic. And even then it may still be too late (2009 Ishag and Mirghani 238-239).
With the lack of transportation, this is causing many women to not reach health attention needed
in time for a proper delivery.
The shortage of healthcare facilities in South Sudan causes a shortage of midwives and
professional healthcare workers. Since there is a lack of the appropriate amount of health
workers, leads these facilities to become over-crowed. Since there are a high number of women
in need of health care attention, but a low amount of healthcare facilities and midwives, makes it
very difficult for almost any women to seek the attention needed in the appropriate and timely
matter. In 2004, there were only three surgeons serving southern Sudan, with three proper
hospitals, and in some areas there was just one doctor for every 500,000 people. With the
shortage of hospitals and professionals, makes it difficult for South Sudan to become more
medicalized when it comes to childbearing and childbirth (2006 Capbell and Graham 1285-
1287). Also, many of the women living in South Sudan do not believe that medical procedures
that may be needed when it comes to giving childbirth. Most people living in South Sudan have
always lacked the medicalization procedures or westernized medication when it comes to almost
any health related issue.
Westernized medicine and biomedical care is not usually an option in this country due to
poverty and shortage of healthcare centers. By both these cases, causes the belief for many
women that it is safe for a delivery at home and/or in un-sanitized environments. For an example,
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many women believe in Traditional Birthing Assistant (TBA) for a proper and healthy delivery.
Traditional Birthing Assistant (TBA) is women from the local village or town, respected among
communities because of their age and experience with childbirth. Relatives often call upon these
women when an expected mother is about to give birth. Many women choose this birthing
process often because they believe in going back to their original family and home to receiving
the help from their mothers or close relatives who believe in this delivery process. Traditional
Birthing Assistant (TBA) are very heavily relied upon, they unfortunately have little or no
training when it comes to midwifery skills and tend to be unable to cope when it comes to an
emergency or complications during childbirth (2011 Browner and Sargent). The Traditional
Birthing Assistant (TBA) lacks many of these healthcare skills and knowledge because of the
minimum education they receive or others poorly train them.
In South Sudan, many women lack education on prenatal and reproduction care. The lack
of education is a major concern not only in the women who are pregnant, but a lack of
knowledge in midwives and Traditional Birthing Assistant (TBA) as well. With South Sudan
becoming a newly independent country, the government is presently overwhelmed with social,
political and economic development that there are no definite strategies to embrace the
importance of ensuring the education of women concerning their reproductive health (2011
Barber). As a result, many girls, even as young as thirteen who are not properly developed yet to
become pregnant, lack the knowledge or have little insight on how to be readily prepared to
deliver a child in a healthy and mature matter (1995 Pitt). Also, with a lack of educational
systems in this country, there are many midwives who lack the essential training needed to
properly give childbirth.
The general health condition on the public in South Sudan is a major concern as well.
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The health issue in this country can increase the chance of women to suffer from a maternal
compilations or death. South Sudan has one of the worst health statistics in the world, due to life-
threatening poverty, poor government capacity, inadequate medicines and supplies in clinics, and
weak infrastructure including: communication, transportation, poor hygiene, illiteracy, and poor
nutrition; all contribute to why their health is a concern. Also, there is a high rate of malaria, the
spread of HIV/AIDS and other sexual transmitted diseases (STD), and many cases of pneumonia
that many people living in South Sudan are suffering from. With the lack of westernized
medicine and biomedical care, the health in this country is also suffering greatly due to the
shortage of medical clinics, medical supplies, and trained staff to properly diagnosis these people
who may be ill or who are at a high risk of dying from such diseases and viruses (2011 Browner
and Sargent).
Pregnant women and children under the age of five are at the greatest risk for illness,
diseases, and mortality amongst everyone else living in South Sudan. Diseases and illnesses such
as malaria, pneumonia, HIV/AIDS, and cholera are some of the most common threats that many
are dying from. Due from the lack of education in health care workers and the difficult access to
skilled care, these diseases and/or viruses can spear easily and possibly even unnoticed. The lack
of healthcare clinics and proper equipment lowers the opportunity for people living in South
Sudan to get tested for HIV and STD and also get proper treatments once diagnosed with malaria
or pneumonia, which makes it easy for such illness and viruses to spread (2012 Green 1578).
The women that are pregnant may catch an illness or disease more rapidly, leaving the women in
an increase chance of maternal death due to a weaker immune system during childbirth.
The healthcare system in South Sudan has an enormous shortage of human resources and
the current health work force comprises a large majority of poorly trained, low-level
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professionals and auxiliary staff, with an absolute shortage of higher-level professional staff and
clinics (2006 Beamon and Kotlba 188). In terms of availability, for every 100,000 people, there
are 0.15 physicians, 0.2 nurses and midwives, and 0.02 pharmacists. The health service
infrastructure and equipment are inadequate, maintained poorly, and unequally distributed
among the regions in this country. Of the 1,487 health facilities that South Sudan has, the rural
areas contain only about 100 health centers, resulting in a ratio of around one health center per
every 75,000 people. Furthermore, there is only one hospital for every 40,000 people, which in
effect, leaves the people living in the rural South Sudan, literally no access to hospital care. Most
of the hospitals and healthcare clinics are provided by international nongovernment
organizations with a low funding system, which decreases the providing for skilled health
workers. Out of the 1,487 health facilities in the ten states of South Sudan, 340 of them
completely lack trained professionals, equipment, or both, which lowers the chances of
healthcare access in this country (2011 Rai and Ramadhan 1141-1142). The major issue of
healthcare services in this country highlights the health consequences of social inequality from a
political and economic perspective. The South Sudan government and The Republic of South
Sudan needs to focus on what needs to be done in order to lower maternal mortality rates in this
country and find equal social status for women who are suffering.
Also, many of these rural areas are going unnoticed and lack the proper care needed in
order to survive. Poor nutrition and un-sanitized drinking water are two main issues that rural
South Sudan faces. Many of the women who are pregnant, suffer from malnutrition, leaving their
bodies weak and fragile during childbirth (2011 Barber). Since many are living in poverty, the
scarce of food is at a high, which is causing many people to starve and go innutrition. The water
sanitation in South Sudan is a major conflict as well. Water sanitation is neglected and has
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become a scarce resource. There is limited access to sanitized water and minimum water points
in rural areas. The lack of water has been a main source of much of the internal conflict with the
people living in poverty (2011 Browner and Sargent 187-188). Lack of sanitized water, food and
nutrition leads to several people living in these rural areas having sever cases of cholera,
suffering from malnutrition, and many other communicable diseases that all may lead to a sever
sickness and even death.
There are many government and nongovernment organizations that are taking action
international that focuses on the reduction of the astounding high rate of maternal mortality in
South Sudan. The Millennium Development Goal number five is targeted to improve maternal
health worldwide, which focuses heavily on South Sudan. The main goal is to decrease maternal
mortality and achieve universal access to reproduction health care (2002 United Nation
Millennium Goal). The World Health Organization (WHO) focuses on finding researches that
are the key indicators on why and how maternal mortality is at a high in South Sudan. The World
Health Organization also is trying to strengthen Comprehensive Emergency Obstetric and
Newborn Care (CEmONC) that is trying to increase the maternal and newborn health in
developing countries (2014 World Health Organization). The Republic of South Sudan is
focusing on improving the overall public health and primary care in their nation. (2011 Rai and
Ramadhan). Finally, the Canadian International Development Agency (CIDA) provides funding
and support for maternal health programs, health clinics, and educational programs in South
Sudan (2014 Foreign Affairs, Trade, and Development Canada). With the help of these
organizations, they are all providing research in finding ways to lower the extremely high rate of
maternal mortality in this country.
South Sudan faces many daunting tasks to improve their overall general health care in
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their nation. Due to this country just becoming independent as of January 2011, the government
system is building their nation from ground zero. By rebuilding their entire national from ground
zero, takes time and dedication in finding what needs to be done to enhance their country. The
Republic of South Sudan is focusing on improving the overall general health system, but is
focusing minimum on the maternal health that this country is suffering from (2012 World Bank).
Some interventions and ways to improve the prenatal and maternal health care in South Sudan
are to ensure availability of adequate healthcare facilities throughout this country. With South
Sudan lacking many clinics, it makes it very difficult for many women to reach the attention
needed with professional care for delivery in an appropriate and timely matter. Since there is a
shortage of healthcare centers in most rural areas in this country, transportation is very scarce
resource as well. The lack of transportation is due to poverty and/or unpaved roads, which forces
women to give birth at their homes or in un-sanitized location. Also, with the lack of healthcare
clinics, reduces the amount of midwives and professional health workers. The lack of midwives
causes women to give birth at home or with a Traditional Birthing Assistant (TBA) that
commonly do not have the necessary supplies and equipment needed for a sanitized delivery.
Many of the Traditional Birthing Assistants (TBA) has very low-level professionally trained
midwifery skills that when in a crisis situation, may lack the knowledge of how to properly
proceed with the procedure.
South Sudan needs to enhance the development of midwives and educate professional
health workers by providing training and educational programs throughout this country. Also,
health centers, midwives, and even Traditional Birthing Assistants (TBA) should empower
women to help themselves. By means of this, women should be aware of the importance of
prenatal care and have a better outlook on their pregnancy; such as change in their attitude
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towards feeling powerless, value the minimum resources they have to try to better their health,
and lastly, acknowledge and learn from any midwife or any other health professional they can on
the maternal health of childbearing.
Lastly, government and nongovernment organizations that work international with South
Sudan are both trying to decrease the maternal mortality rate and improve the maternal care.
With the help of these organizations this could enhance educational programs, supply medical
needs to women for childbirth, and empower and encourage women to better their lifestyle
during prenatal care.











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References
Barber, Rebecca
2011 Getting it right from the start: priorities for action in the new Republic of South Sudan
Oxford, England: Oxfam GB
Beamon, Benita and Kotleba, Stephen
2006 The International Journal of Logistics Management: Inventory management support
system for emergency humanitarian relief operations in South Sudan 17 (2): 187-212
Browner, CH and Sargent, Carolyn
2011 Reproduction, globalization, and the state: new theoretical and ethnographic perspectives
Durham, New York: Duke University Press
Campbell, Dr. Oona and Graham, Wendy
2006 The Lancet: Strategies for reducing maternal mortality: getting on with what works 368
(9543): 1284-1299

Foreman, Kyle and Hogan, Margaret
2010 The Lancet: Maternal mortality for 181 countries, 1980 -2008: a systematic analysis of
progress towards Millennium Development Goal 5 375 (9726): 1609-1623
Green, Andrew
2012 The Lancet: Health care in South Sudan at a crossroads 379 (9826): 1578
Ishag, Adam and Mirghani Omer
2009 The Royal Society of Medicine Journals: High maternal mortality and stillbirth in the
Wad Medani Hospital, Central Sudan, 2003-2007 39 (4) 238-239
Pitt, Mark
1995 Women's schooling, the selectivity of fertility, and child mortality in Sub-Saharan Africa
Washington D.C: World Bank Publications
Rai, Rajesh and Ramadhan, Ally
2011 Prioritizing Maternal and Child Health in Independent South Sudan: Maternal and Child
Health Journal 16 (6):11391142
World Bank
2012 Education in South Sudan: Status and Challenges for a New System
Washington D.C: World Bank Publications
United Nation Millennium Goal
2002 Goal 5: Improve Maternal Health

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World Health Organization
2014 Country profile: South Sudan
Foreign Affairs, Trade, and Development Canada
2014 Canada Helping to Improve Maternal and Child Survival in South Sudan