Maternal, newborn and child health
Every child has the right to survive and thrive
Challenge
Lesotho continues to face critical challenges in maternal and neonatal health, with some of the highest mortality rates in East and Southern Africa. According to the 2023/24 Lesotho Demographic and Health Survey (LDHS), the maternal mortality ratio stands at 530 deaths per 100,000 live births, while the neonatal mortality rate is 26 per 1,000 live births. The stillbirth rate is also troubling at 27 per 1,000 total births. Alarmingly, 50 per cent of under-five deaths in the country occur within the first month of life, underscoring the urgency of addressing neonatal health and survival.
Despite these grim outcomes, the country has achieved commendable coverage across several maternal health indicators. Antenatal care coverage with four or more visits (ANC 4+) stands at 82 per cent, skilled birth attendance at 92 per cent, postnatal care within two days of delivery at 79 per cent, and facility-based deliveries at 86%. These statistics reflect strong service utilization; however, the persistently high mortality rates point to significant gaps in the quality and effectiveness of care provided.
A substantial proportion of maternal and neonatal deaths occur in health facilities, raising serious concerns about the quality of clinical care. Many facilities are ill-equipped to manage obstetric and neonatal emergencies and often lack the infrastructure necessary to support complex cases. In addition, some healthcare providers, particularly at the primary care level, lack the competencies for timely diagnosis and appropriate referral of pregnancy and childbirth complications. These gaps contribute to preventable maternal and neonatal fatalities, even when patients access health services.
Access to quality health care remains a significant challenge, particularly for those living in rural and remote areas. Geographic barriers, high transportation and service costs, and poor road infrastructure delay timely access to skilled care. Even when patients reach facilities, they are frequently confronted with stockouts of essential medicines and medical supplies, which further compromise care and outcomes.
Systemic challenges also play a significant role in undermining maternal and neonatal health outcomes. Weak referral systems and limited integration of maternal, newborn, and child health (MNCH) services with HIV and nutrition programs disrupt the continuity of care. A decline in health sector financing, combined with fragmented coordination between national and district-level stakeholders, hinders the delivery of cohesive and effective health services.
Solution
In response to these challenges, UNICEF is supporting a system-wide approach to improve the quality, accessibility, and equity of MNCH services in Lesotho. This includes strengthening primary health care and community-based platforms through investments in workforce capacity-building, digital health tools, and more efficient referral systems. UNICEF also advocates for the development and implementation of a Primary Health Care (PHC) strategy, along with policies aimed at eliminating mother-to-child transmission (eMTCT) of HIV.
Working in close partnership with the Government of Lesotho and development partners, UNICEF promotes the integration of MNCH services with key areas such as immunization, HIV, nutrition, and water, sanitation, and hygiene (WASH). Support is also provided for the institutionalization of community health workers into the formal health system, expansion of adolescent and youth-friendly health services, and the use of real-time health data to improve planning, resource allocation, and accountability.
By addressing system bottlenecks and strengthening the continuum of care—from pregnancy through early childhood—UNICEF aims to ensure that every woman and child in Lesotho has access to timely, high-quality, and life-saving care. These efforts are critical to reversing the current mortality trends and achieving long-term improvements in maternal and child health outcomes.