Sudanese refugee women in northeastern Central African Republic (CAR) face an increasing risk of dying in childbirth as cuts to US funding hit already fragile maternity services, aid agencies have warned.

Tens of thousands of people have fled fighting in Sudan’s Darfur region into CAR’s remote Vakaga province, overwhelming a health system that was struggling even before the new arrivals. CAR is among the countries with the highest maternal mortality rates in the world, and the influx has stretched the few functioning facilities to breaking point, humanitarian agencies say.

In and around Birao, a small town near the Sudanese border, a handful of clinics supported by the United Nations Population Fund (UNFPA) provide antenatal checkups, emergency obstetric care and basic delivery services for both refugees and locals. Those services rely heavily on international funding, including contributions from the United States that have helped pay for midwives, medicines and equipment.

Aid organisations say reductions in US foreign assistance are forcing them to reassess programmes and staffing levels just as needs are rising. Some facilities have already cut back on overnight staffing and outreach activities, raising fears that more women will deliver at home without skilled help or life-saving drugs.

Refugee women, many of whom arrived after walking for days through the bush while pregnant, face multiple risks. Malnutrition, malaria and untreated infections are common. Many report never having seen a midwife before reaching CAR and have little information about danger signs in pregnancy. Health workers say complications such as obstructed labour, haemorrhage and eclampsia are frequent — conditions that can be fatal without rapid intervention.

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Local women in Vakaga are also affected. With limited roads, insecurity and few ambulances, reaching the nearest clinic can take hours. When facilities run short of supplies or staff, families often turn to traditional birth attendants or delay seeking care until it is too late.

UN and NGO officials warn that further funding cuts could mean closing some maternity wards, reducing the number of trained midwives and scaling back emergency referral systems. That would undermine recent gains in encouraging women to give birth in health centres rather than at home.

Humanitarian agencies are appealing to donors to sustain and increase support for maternal health services in CAR, arguing that the cost of maintaining midwives and basic obstetric care is small compared with the human cost of preventable deaths. They say that without predictable funding, both refugee and host community women in one of the world’s poorest countries will pay the price.