This paper examines the barriers to maternal health services in Betou, a remote rural locality in the northern Republic of Congo, where geographic isolation, inadequate transportation, poor road infrastructure, and severe healthcare workforce shortages contribute to a maternal mortality rate of 696 per 100,000 live births, and less than half of pregnant women receive even one prenatal consultation.
Abstract
Reducing maternal mortality remains a critical global health challenge, particularly in sub-Saharan Africa, where 179,000 women die annually during pregnancy and childbirth. This essay examines the barriers to maternal health service utilization in Betou, a remote rural locality in the northern Republic of Congo, located 1,240 kilometers from the capital, Brazzaville, and 250 kilometers from the nearest level II hospital.
Data from a recent study in the region revealed that of 2,127 pregnant women, only 49.7% received at least one prenatal consultation, and 44.19% delivered at a health facility. The maternal mortality rate was 696 per 100,000 live births, and the neonatal mortality rate was 22.3 per 1,000 live births.
Several interconnected obstacles were identified through a literature review: geographic isolation, with a single health center serving approximately 16,511 square kilometers; inadequate transportation infrastructure, including poor roads prone to flooding and reliance on motorcycle taxis unsuitable for patient transport; and severe healthcare workforce shortages, with only three general practitioners and five midwives serving a population of 53,186 inhabitants, far below the World Health Organization’s recommended minimum of 23 health workers per 10,000 population.
These barriers result in high rates of home deliveries, births unattended by skilled professionals, and preventable maternal and neonatal deaths. Addressing maternal health disparities in rural sub-Saharan Africa requires comprehensive interventions that address infrastructure development, transportation access, and strengthening the healthcare workforce.
Keywords: maternal mortality, rural health, healthcare access, Republic of Congo, prenatal care, sub-Saharan Africa
Key Takeaways
The data from Betou reveal a stark picture of maternal health disparities in rural Congo, with only 49.7% of pregnant women receiving at least one prenatal consultation and a maternal mortality rate of 696 per 100,000 live births, far exceeding global targets. Geographic isolation is a primary barrier: Betou is 1,240 kilometers from the capital, Brazzaville, and 250 kilometers from the nearest level II hospital, forcing women to travel long distances for essential care.
Transportation challenges compound these geographic barriers, as poor roads prone to frequent flooding limit vehicle access, leaving motorcycle taxis as the only available transport option, which are neither adequate nor safe for transporting pregnant women or patients in emergency situations. The severe shortage of healthcare workers further undermines access to quality care, with only three general practitioners and five midwives serving a population of over 53,000, well below the World Health Organization’s recommended minimum of 23 health workers per 10,000 population.
These interconnected obstacles result in high rates of home deliveries, births unattended by skilled professionals, and preventable maternal and neonatal deaths. The findings underscore that improving maternal health outcomes in rural sub-Saharan Africa requires comprehensive strategies addressing infrastructure, transportation, and healthcare workforce development simultaneously.
“The obstacles linked to access to health care in rural Sub-Saharan Africa result from the isolation of the area, the lack of transport, the lack of technical platforms, and the lack of staff, and in the rural area of Betou, these obstacles seem more marked and negatively impact maternal and child health.”
By Dr Grâce Mabiala-Maye
Physician and Maternal Health Researcher
