Devpro Resource Centre

Sudan (Southern Sudan)

A plan for maternal health in post-conflict Southern Sudan

© UNICEF Sudan/2008/Heavens
A mother brings an infant for a check-up at the UNICEF-supported El Sabah Hospital in Juba, Southern Sudan.

Context and challenge: Protracted conflict, lack of skilled birth attendants, poor infrastructure

After 21 years, conflict between the north and south of the Sudan came to an end in 2005. While the fighting has mostly ceased, Southern Sudan is facing another struggle – against maternal and neonatal mortality.

According to the 2006 Sudan Household Health Survey, the maternal mortality ratio for Western Equatoria, a province in Southern Sudan, stood at 2,327 deaths per 100,000 live births, one of the highest in the world. The 2006 neonatal mortality rate was 51 deaths per 1,000 live births, significantly above the Sudan’s national ratio of 41 deaths per 1,000 live births. Overall health-care coverage, mostly managed through a small number of non-governmental organizations, is estimated at just 25 per cent.

Even when health care is available, maternal health services are limited and not often used. Part of the reason may be a lack of education. The United Nations Population Fund estimates that, in 2006, the literacy rate for Southern Sudanese women was just 12 per cent, compared with 37 per cent for men; women, therefore, have little access to health information. Another possible reason is that pregnant women must travel long distances on foot to reach antenatal centres; consequently, attendance rates vary sharply, depending on location.

Although most of the causes of maternal death – including prolonged obstructed labour, haemorrhage, sepsis and eclampsia – could be managed by better-trained attendants, fewer than 15 per cent of births in Southern Sudan are attended by skilled health personnel, and 80 per cent take place at home under the supervision of either relatives, traditional birth attendants or village midwives (a female birth attendant who has typically received around nine months of training). In all 10 states of Southern Sudan, midwives, traditional birth attendants and other maternal and neonatal care providers lack the necessary training required to perform simple lifesaving or nursing procedures.

Lack of equipment and supplies, poor referral systems, and inadequate physical infrastructure and transportation also impede the delivery of health-care services. Post-natal care services are virtually non-existent, despite the fact that most of the maternal and newborn deaths in Southern Sudan occur during the post-natal period.

© UNICEF Sudan/2008/Heavens
New mothers weigh their children at the UNICEF-supported Kator Health Centre in Juba, Southern Sudan. The centre was virtually inoperative at the end of Sudan's civil war in 2005, but now serves hundreds of mothers and children every week.

Action: Interim Health Policy for 2006–2011 aims to improve health services while protecting women's rights

Against this background, the Government of Southern Sudan and its partners are making efforts to strengthen maternal health services. The Interim Health Policy for 2006–2011 outlines an integrated approach that recognizes the need to improve health services while protecting women's rights. The Ministry of Health has committed to establishing more primary, reproductive and maternal health facilities, while supporting the use of mass media and counselling services to disseminate information on nutrition, harmful traditional practices and sexual health.

To meet immediate health-care needs, community midwives who have basic qualifications are being ‘fast-tracked’, with support from UNFPA. In June 2006, the first fistula repair centre in Southern Sudan was established at the Juba Teaching Hospital.

© UNICEF Sudan/2008/Heavens
A young child receives a vaccination at the UNICEF-supported Kator Health Centre, Juba, Southern Sudan.

Impact and Opportunities: Coordination of maternal and neonatal health activities in each state

To accelerate the implementation of this strategy, the Government has established the Reproductive Health Directorate, and is recruiting state coordinators to facilitate, monitor and coordinate maternal and neonatal health activities in each state. UNICEF is supporting the expansion of antenatal and emergency obstetric services in several states, as well as the dissemination of key health messages over the radio and through community outreach.

There are challenges ahead. The return of refugees and the movements of many displaced populations, Southern Sudan’s high fertility rate (6.7) and increasing rates of HIV infection among some populations necessitate a systematic health programme.

12 February 2009




To learn more

Central Bureau of Statistics and Southern Sudan Commission for Census, Statistics and Evaluation, Sudan Household Health Survey 2006, CBS and SSCCSE, Khartoum.

UNICEF, The State of the World’s Children 2009: Maternal and newborn health, New York, January 2009 | access report

UNICEF Sudan Resources | website

UNFPA Sudan Country Office | website

WHO, Neonatal and Perinatal Mortality: Country, regional and global estimates, 2007 | access report

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