At the Bangui Paediatric Complex, Central African Republic's only specialist neonatal and paediatric hospital, based in the capital city, new mothers and the health workers who care for them navigate joy and grief against a backdrop of insecurity amid conflict - and shrinking international funding.

In 2025, UNFPA, the United Nations Population Fund, received just 45 per cent of its funding needs for sexual and reproductive healthcare in the country.

Young mother Jypsie, 20, is among those impacted. While pregnant, she attended every antenatal check she could. But after seven months, cramps left her unable to walk, and she delivered twins prematurely in the middle of the night at home, with her husband’s mother doing her best to help. 

One of the newborns survived. The other died of respiratory distress before the family made it to the specialist hospital in Bangui, located some 22 km from home. Jypsie says she is struggling to find words for her grief. 

In the Central African Republic, only around 40 per cent of births are attended by skilled personnel. 

At the hospital, Jypsie accumulated a debt of around US$27 for care. While modest by a global measure, it can be a significant amount for families in a country that is one of the poorest in the world. It created a financial burden for Jypsie and her husband, who struggles to find jobs as a builder.

Every day at the Bangui Paediatric Complex, mothers rely on experienced midwives for support, while newborns with complications receive specialist care and children of all ages recover from illness. At the same time, a new generation of doctors receives training, as the facility serves as the country’s only university hospital dedicated to paediatric care.

It is also a hospital under severe pressure. For years, maternal and neonatal care at the facility had been free of charge, sustained by international partners, including UNFPA. As global humanitarian funding shrinks, challenges grow. Today, the hospital is no longer able to sustain free care for all.

Jypsie’s neighbour and friend Belicia, 24, arrived at the hospital by ambulance when she was eight months pregnant, thanks to a free emergency service that may not exist much longer. A student and mother to a 7-year-old, she now has newborn triplets, while her husband is looking for work.

Belicia has not received any counselling on family planning following the birth – a gap that health workers note is increasingly common as services are scaled back. But in the maternity ward, surrounded by midwives, she has quality care. 

Clara Abessende is a Bangui-based midwife. She had run reproductive health services for nearly a decade in Birao, a remote town near the border of Chad and Sudan. She recalls patient numbers increased from 60 to 200 a day as people fled the conflict in Sudan that erupted in 2023. When her contract was abruptly ended in 2025 amid funding cuts, she wept, and so did her patients.

Clara speaks with urgency about what has been lost due to funding cuts, including teams of community outreach workers who had provided antiretroviral treatment for HIV and “dignity kits” containing essential hygiene supplies for women and girls, and also referred rape survivors to care, among other key services. 

Clara says the risks are greatest for women who are already vulnerable. For instance, she fears survivors of sexual assault will not be able to find a health clinic or support centre able to receive them.

A $5.8 million contribution from the Italian Agency for Development to UNFPA is helping to support maternal and neonatal services at the Bangui hospital through October 2026. But it is not enough to cover all costs, including the cost of care that was previously provided for free. 

The line between life and death is fragile in the Central African Republic. “If services are not free, families wait,” says paediatrician Simplice Kango. “And when they wait, children die.”