No Woman Left Behind: Listening to Women to Transform Maternal and Newborn Care
Today, April 7th, 2025, is World Health Day and marks the launch of a year-long campaign on maternal and newborn health. Titled Healthy Beginnings, Hopeful Futures, the campaign calls on governments and the global health community to intensify efforts to end preventable maternal and newborn deaths and to prioritize women’s long-term health and well-being.
At KIT Institute, our work in maternal and neonatal health aligns closely with this mission, striving for lasting improvements in care and outcomes. This blog explores our most recent work in this field.
Delays in emergency obstetric care still drive high maternal mortality rates
Between 2023 and 2025, KIT Institute conducted the Service Delivery Redesign (SDR) Formative Research project, in collaboration with Design Innovation Group, Proportion Global, the University of Geneva, the Aga Khan University (Pakistan), Laboratoire d’Études et de Recherches sur les Dynamiques Sociales et le Développement Local (Niger), Centre de Support en Santé Internationale (Chad), and the Université Catholique de Bukavu (Democratic Republic of Congo). The project was financed by the World Bank and the Global Financing Facility.
The project aims to enhance maternal and newborn health (MNH) services and improve women’s access to emergency obstetric and neonatal care (EmONC) by informing a service delivery redesign process (SDR). SDR is a systems-based approach focusing on the reorganisation of a health system to improve equity, quality and health outcomes. It transcends from a focus purely on access to care to the idea that improvement can only be achieved if, within this care system, quality is invested in and brought to scale. Delays in receiving adequate emergency obstetric care persist and contribute to the high rates of maternal mortality globally.
Chad has one of the highest maternal mortality rates in the world, with 1,063 maternal deaths per 100,000 live births—nearly five times the global average of 223. In the Democratic Republic of Congo (DRC), the rate stands at 547 deaths per 100,000 live births, more than twice the global average.
These deaths are largely driven by critical delays in accessing timely and appropriate care. In Chad and the DRC, the formative research documented significant delays in seeking care at health facilities. Women identified the high cost of services and transportation—as well as family and community norms that favour traditional birth attendants located closer to home—as key factors influencing their care-seeking behaviour.
Adequate person-centred care is not guaranteed
Reaching a suitable facility during an obstetric emergency poses another major challenge. In Batha Province, Chad, only 17% of women live within two hours of a functional hospital offering comprehensive obstetric care. Even when women do manage to reach a facility, receiving timely and adequate person-centred care is not guaranteed. Health workers often operate under difficult conditions, including interruptions in water supply, electricity, blood availability, and essential equipment for emergency neonatal care.
Women’s preferences are also not always respected—such as the choice to have a companion during childbirth, maintain privacy, or be attended by a female healthcare provider.
Approaches require listening to women and supporting families
Addressing these complex challenges requires human-centred approaches grounded in the lived experiences and needs of women, families, and healthcare providers.
The SDR formative research embraced this principle by placing the experiences and perspectives of women at the heart of the redesign process—while also recognising the working conditions of healthcare providers as essential to delivering quality care. Women and providers were not only central to qualitative and quantitative data collection, but also actively involved in participatory consultations to validate findings and co-create solutions to key issues related to the quality and accessibility of maternal and newborn health services.
In the DRC, the process supported women and healthcare providers in Masina, an urban area of the capital city Kinshasa, to develop strategies aimed at improving how women are received in health facilities—a critical factor influencing perceived quality of care. They also developed the idea of the BWAKISA card, a collective payment mechanism managed by a community association, which helps cover service fees for women who need financial support to access care.
Over the course of design sessions with women and healthcare providers in Chad, a community transport mechanism linked to maternity waiting homes was developed. These sessions centred user experiences and needs to ensure the resulting solutions effectively addressed the geographic barriers limiting access to maternal healthcare in rural areas.
No woman or newborn should be left behind
The SDR research underscores the need for human-centered approaches. By listening to women and involving communities, we can overcome barriers to care. KIT remains committed to supporting respectful, accessible maternal and newborn health services that put women first. As the Healthy Beginnings, Hopeful Futures campaign unfolds, sustained commitment to innovative, community-driven solutions will be essential in ensuring that no woman or newborn is left behind.
If you would like to learn more about ongoing maternal and neonatal health work at KIT, please contact our advisors: Irene de Vries or Heloise Widdig.
