A free childbirth program ends in eastern Congo at the worst of times
[December 11, 2025]
By RUTH ALONGA and CAITLIN KELLY
GOMA, Congo (AP) — In a maternity ward in eastern Congo, Irene Nabudeba
rested her hands on her bulging midsection, worried about giving birth
in a city under rebel control.
The conflict that flared this year has left many medical supplies
stranded beyond the front line. Infrastructure like running water has
collapsed, along with the economy in Goma, the region's humanitarian and
commercial hub.
And now the one glimmer of hope for mothers — a free maternity care
program offered by Congo's government — has ended after it was not
renewed in June. It was not clear why, and Congolese did not respond to
questions.
Nabudeba has five children and wonders whether the sixth will survive.
“At the hospital, they ask us for money that we don’t have. I’m pushing
myself to come to the consultations, but for the delivery ... I don’t
know where I’ll find the money,” she said at the Afia Himbi health
center.
Women are losing access to maternal care
Several women told The Associated Press they cannot afford maternal care
after Congo's program that was aimed at reducing some of the world's
highest maternal and neonatal death rates ended earlier this year. The
program launched in 2023 offered free consultations and treatment for
illnesses and at-risk pregnancies at selected health facilities across
the country.
Congo ranked second in maternal deaths globally with 19,000 in 2023,
behind Nigeria's 75,000 deaths, according to U.N. statistics.
Health workers said more women in Goma are now giving birth at home
without skilled help, sometimes in unsanitary conditions, leaving them
vulnerable to hemorrhage, infection or death.
Clinics and hospitals were already struggling after the M23 rebels,
backed by neighboring Rwanda, seized Goma in an escalation of fighting
in January.
Essential services are cut off as fighting continues
Although clashes subsided amid U.S.- and Qatar-led peace efforts,
fighting escalated again in recent days and the conflict has collapsed
public institutions, disrupted essential services and displaced more
than 700,000 people, according to the U.N. humanitarian office.
In Goma, the armed rebels are seen everywhere, making a pregnant woman's
walk to clinics another source of anxiety.
Freddy Kaniki, deputy coordinator of M23, asserted to the AP that the
free maternal care “was not renewed because it was a failure,” without
elaborating. Congolese officials did not respond to questions.
Rwanda denies supporting the M23 despite U.N. experts saying they have
evidence of it. Rwanda prides itself on health care and recently signed
a five-year deal with the U.S. for investment of up to $158 million in
its own health care sector.
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Ernestine Baleke receives pre-natal care that used to be free at the
Rehema Health Center in Goma, Democratic Republic of Congo, Nov. 14,
2025. (AP Photo/Moses Sawasawa)
 The collapse of essential services
in rebel-held areas, combined with mass displacement and insecurity,
has left civilians struggling to access even basic care.
An International Committee of the Red Cross assessment in September
found that at least 85% of health facilities were experiencing
medicine shortages, and nearly 40% have seen an exodus of staff
after the conflict surged in the provinces of North Kivu and South
Kivu.
The ICRC in October said 200 health facilities in eastern Congo had
run out of medicines because of looting and supply disruptions.
Doctors Without Borders, or MSF, has reported hospitals attacked,
ambulances blocked and medical staff threatened or killed.
Few can afford to pay even $5 for medical assistance
Childbirth at a clinic in Goma now costs $5 to $10, out of reach for
many families in a region where over 70% of the population lives on
less than $2.15 a day, according to the World Bank.
Franck Ndachetere Kandonyi, chief nurse at the Afia Himbi health
center, said the number of births there under the free program had
jumped from around five a month to more than 20. But the program
ended in June.
Facing a table of statistics in his office, Kandonyi said the number
of births per month is now down to nine.
“When a parent cannot even pay 10,000 Congolese francs ($4.50) for
their wife’s or child’s care, it’s a real problem,” the nurse said.
Meanwhile, banks have closed in Goma, prices have soared and the
dollar has depreciated.
Nabudeba's husband, a driver, has been unemployed since January. She
said her family is barely surviving.
“When the war broke out, we lost all our resources,” she said.
“Lately, the situation has not been favorable, and we are suffering
greatly.”
Across town at the Rehema Health Center, Ernestine Baleke waited for
help with her ninth pregnancy, with concern on her face. She said
she doesn't know where she will get money for the delivery.
Her husband lost a factory job when the place was looted earlier in
the conflict, she said. Then their house burned.
“I don’t even have 100 francs (45 cents) in my pocket,” Baleke said.
She walks more than half a mile to the hospital because she cannot
afford transportation. Three months remain before her delivery.
“The authorities must restore free health care," Baleke said. “We
risk dying in our homes while giving birth.”
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