Giving birth should not be a death sentence – Eno Safo writes

I am not a mother. I have never experienced the pain of labour or the fear that comes with bringing a child into the world yet. But after reporting on maternal health and speaking to doctors, midwives and public health experts, I find myself asking one question that refuses to leave me: why should the outcome of childbirth depend on where a woman lives?

Why should a woman like me, living in an urban area with hospitals within reach, have a vastly different chance of surviving childbirth than a woman in a remote village? Why should geography decide whether a child grows up with a mother?

I cannot imagine the mental torture. Knowing your due date is approaching. Feeling the first contractions. Wondering whether you’ll reach a health facility before complications begin. Wondering whether an ambulance will arrive. Wondering whether the clinic will have blood for a transfusion, life-saving medicines or a skilled midwife if something goes wrong. For too many women in rural Ghana, childbirth is not simply the beginning of new life—it is an anxious journey where survival is never guaranteed.

That reality sits uneasily alongside Ghana’s progress in maternal healthcare. The country has expanded Community-based Health Planning and Services (CHPS) compounds, increased skilled birth attendance and reduced maternal deaths over the past two decades. Yet far too many women continue to die from complications that modern medicine has known how to prevent for generations.

The numbers are sobering. The latest World Bank and World Health Organization model estimates place Ghana’s maternal mortality ratio at 234 deaths for every 100,000 live births in 2023—an improvement of about 15 percent over the previous five years, but still more than three times the United Nations Sustainable Development Goal target of fewer than 70 deaths per 100,000 live births by 2030.

Ghana’s own 2017 Maternal Health Survey, which remains the country’s most comprehensive national assessment and continues to guide many policy discussions, estimated an even higher 310 maternal deaths per 100,000 live births. The figures differ because they use different methodologies, but they point to the same painful reality: hundreds of Ghanaian women still die every year while giving life.

Most of these deaths are preventable. Severe bleeding after childbirth, dangerously high blood pressure during pregnancy, infections and obstructed labour remains the leading causes. Health professionals have known for decades how to treat these emergencies. The challenge is ensuring women reach skilled care before it is too late.

Too often, the greatest barrier is not medicine but access. Rural districts continue to face shortages of midwives, doctors and specialist obstetric services. Some communities rely on a single midwife serving several villages, while lower-level facilities often lack the capacity to perform emergency caesarean sections or provide safe blood transfusions. Every additional kilometre between a pregnant woman and emergency obstetric care increases the risk that she may never return home.

Then there is the journey itself. An ambulance may be stationed miles away. Roads become nearly impassable during the rainy season. Mobile phone coverage can fail at the worst possible moment. By the time a woman reaches a district hospital capable of performing life-saving surgery, the window to save her—or her baby—may already have closed.

That reality came alive for me through the story of Adwoa, a 27-year-old expectant mother from a farming community in northern Ghana. Labour began before dawn, but the nearest health facility with delivery services was several kilometres away. Her husband borrowed a motorbike because no commercial transport was available. Every bump in the road intensified her pain.

When they finally arrived, health workers realised her condition was beyond what the clinic could manage. She needed immediate referral. The ambulance was unavailable. Essential medicines were limited. The staff did everything they could while desperately searching for alternative transport. Adwoa survived after eventually reaching a larger hospital. Her baby did not.

I keep wondering whether the outcome would have been different had she lived in Accra, Kumasi or Takoradi. Would her child still be alive if distance had not become another medical complication?

Other countries with similar economic constraints have shown that progress is possible. Rwanda dramatically reduced maternal deaths by strengthening community health workers, improving emergency referrals and establishing maternal waiting homes for women living far from hospitals. Ethiopia invested in rural health extension programmes and deployed more skilled birth attendants to underserved communities. Their experience proves that limited resources need not condemn women to preventable deaths.

Ghana already knows what needs to be done. The country must drastically increase targeted maternal health funding and aggressively deploy more skilled birth attendants and midwives to underserved rural communities. CHPS compounds need stronger referral systems, reliable stocks of essential medicines, dependable ambulance coverage, functioning blood transfusion networks and roads that emergency vehicles can actually use.

The questions confronting policymakers are uncomfortable, but they demand answers. Why do rural districts continue to struggle to attract and retain skilled midwives while urban centres remain comparatively better staffed? Why should the quality of maternal healthcare still depend so heavily on where a woman calls home? And as government develops its new 2026–2030 Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition Strategic Plan, how will success be measured if women in remote communities continue to die from preventable complications?

Every maternal death creates an emptiness that statistics cannot capture. A child grows up without a mother. A husband carries grief that never fully leaves. A family loses its anchor. A community loses a woman whose future ended while bringing another life into the world.

As someone who hopes one day to become a mother, I cannot accept that childbirth should feel safer simply because of the city I live in. No woman should have to pray that distance, poor roads or an empty medicine cabinet do not decide her fate. Motherhood should never become a test of geography. Until every woman—whether in Accra or the most remote village—has an equal chance of surviving childbirth, Ghana’s healthcare system still has unfinished work.