Globally, significant strides have been made in reducing maternal mortality, as per the recent maternal mortality estimates, with a 34-40% decline between 2000 and 2023. However, progress has slowed since 2016, with an estimated 260,000 women still dying from maternal causes in 2023, roughly one every two minutes. Low- and middle-income countries bear a disproportionate burden, with Sub-Saharan Africa accounting for nearly 70% of global maternal deaths, where a woman faces a 1 in 55 lifetime risk. All women need access to high-quality care during and after pregnancy, and all births should be attended by skilled health professionals. Midwives are crucial for improving maternal and newborn outcomes, capable of providing 90% of essential sexual and reproductive health services and potentially averting over 4.3 million deaths annually by 2035 when properly educated and integrated into health systems.

Rwanda has achieved remarkable progress in reducing its maternal mortality ratio (MMR) from 210 deaths per 100,000 live births in 2014/15 to 105 in 2023. This reduction, highlighted in the fifth health sector strategic plan (HSSP V) 2025/2029, is attributed to expanded midwifery services and improved healthcare access in rural areas. UNFPA and the Government of Rwanda prioritize strengthening the midwifery profession through high-quality education, association, regulation, and midwifery-led care models, offering valuable lessons for other regions.

Despite this progress, Rwanda still faces significant challenges in reducing preventable maternal deaths. The HSSP V (2025-2029) identifies critical issues in healthcare service quality, noting that most maternal (83%) and neonatal (85.9%) deaths occur in hospitals. This indicates deficiencies in care, non-adherence to clinical protocols, and delayed referrals. The primary preventable causes of maternal deaths in Rwanda are obstetric hemorrhage (45%), hypertensive disorders (14%), and pregnancy-related infections (13%).

A severe shortage of skilled health professionals exacerbates these challenges. Rwanda's healthcare worker density is 1 per 1,000 people, well below the WHO's recommended 4.45, compounded by inadequate numbers, an imbalanced skills mix, unequal distribution, and high attrition rates. Teenage pregnancy remains a significant concern, endangering young mothers and their children. Additionally, progress in reducing stillbirths has been slow, partly due to gaps in data collection and surveillance.

To address these issues, UNFPA Rwanda collaborates with the Ministry of Health and other agencies to improve maternal and neonatal health outcomes through targeted investments. Aligned with Rwanda's National Strategy for Transformation (NST2) and HSSP V, UNFPA partners with the government to focus on reproductive, maternal, neonatal health, including high-impact family planning interventions. This partnership centers on modernizing health infrastructure, community engagement and empowerment, leveraging data and innovation, enhancing quality of care through primary health care, and strengthening the health workforce.

UNFPA is committed to supporting several high-impact interventions:

• Enhancing Maternal and Newborn Health Quality of Care: This aims for equitable access to essential health services by strengthening Emergency Obstetric and Newborn Care (EmONC) services, including access to innovative life-saving commodities, improving antenatal and postnatal care, and ensuring skilled birth attendance. Quality of family planning services is also supported. Digital tools are crucial for data management.
• Strengthening the Health Workforce: The ambitious 4x4 reform is central to increasing the quantity and quality of healthcare workers, including midwives, doctors, and nurses. UNFPA supports expanding the quality and capacity of midwifery training, improving career development, and implementing retention strategies.
• Leveraging Data and Innovation: UNFPA supports the digital health system and improves data systems through Maternal and Perinatal Death Surveillance and Response (MPDSR) to identify causes of mortality and near misses, enhancing accountability and care quality.
• Community Engagement and Empowerment: UNFPA emphasizes engaging men as partners, promoting positive parenting, and utilizing Community Health Workers (CHWs) to accelerate the reduction of preventable maternal morbidity and mortality by addressing delays in seeking care.

Addressing maternal mortality (SDG 3.1) requires multisectoral action and collaboration, as most deaths are preventable. Beyond biomedical factors, social determinants like education, income, gender, and social inequalities impede access to sexual and reproductive health services for Rwandan women, especially in rural areas. UNFPA keeps advocating for a more comprehensive approach that promotes dignity and human rights, combined with strengthened health systems (more staff, better supplies, accountability),being essential for universal coverage of quality maternal health services.