Policy interventions to improve safe-motherhood services in conflict-affected settings in Africa: A scoping review

Ensuring access to safe-motherhood services continues to be a serious global health priority, especially in low- and middle-income countries where rates of maternal illness and death remain excessively high. Safe Motherhood is concerned with maintaining the health of the woman and her newborn throughout the process of pre-conception, pregnancy, childbirth and the post-delivery period (Bagherzadeh et al., 2021). Although there have been substantial improvements in maternal health worldwide, outcomes in areas affected by conflict remain poor. This is largely due to breakdowns in health systems, damaged infrastructure, and limited access to essential resources. Baaf, (2020) reports that over 60% of avoidable maternal deaths occur in environments marked by war, displacement, and political unrest. Africa continues to bear a disproportionate burden of protracted crises and armed conflicts. In the last decade alone, over 30 armed confrontations have been recorded across the continent, with millions of civilians, particularly women and children, bearing the brunt of these crises (Nasreldin et al., 2024). Armed conflict undermines political and economic stability and severely disrupts health service delivery. In such environments, medical facilities are often attacked or evacuated, healthcare workers are displaced or overwhelmed, and critical supply chains like those carrying maternal medicines and equipment are frequently severed (Okeke et al., 2024). In conflict-affected and fragile settings, expectant mothers often face delays in accessing medical care, a shortage of trained healthcare providers during childbirth, and the breakdown of emergency and referral systems. These challenges increase the risk of maternal deaths from otherwise manageable complications like severe bleeding, infections, and prolonged labor (Zhang et al., 2023). For example, South Sudan’s maternal mortality ratio remains one of the highest globally at an estimated 1,150 deaths per 100,000 live births, largely attributed to the nation’s prolonged instability and under-resourced health infrastructure (Sami et al., 2020). To address these pressing issues, policy strategies have become essential in promoting and safeguarding maternal health within fragile and conflict-impacted environments. Such strategies consist of the inclusion of maternal health in emergency humanitarian frameworks, the use of mobile health units, the empowerment of community-based health workers and the development of reproductive health policies that are specifically adapted to unstable and crisis-prone settings (Dawson et al., 2022; Sami et al., 2020). Regional and international organizations, including the African Union, working alongside national health ministries and global health partners, have played a key role in formulating and implementing policies aimed at ensuring uninterrupted maternal healthcare services, even in highly unstable and conflict-prone settings (Okeke et al., 2024). However, the implementation and effectiveness of these policies are highly context-dependent, often constrained by variable levels of political commitment, inadequate funding, sociocultural barriers, and weak governance structures (Bigirinama et al., 2024). Although previous studies have examined various components of maternal health service delivery in humanitarian and resource-constrained environments, there is still an evident gap in comprehensive analyses that center specifically on policy-level responses to safe motherhood challenges in Africa’s conflict-affected regions. Much of the existing literature prioritizes clinical interventions or logistical strategies within emergency response systems, often overlooking a systematic evaluation of the broader policy frameworks that influence how these services are delivered (Ansah et al., 2024; Oladimeji & Fatusi, 2022). This scoping review seeks to address this gap by identifying, mapping, and analyzing policy interventions aimed at enhancing safe-motherhood services in conflict-affected settings across Africa. By synthesizing existing evidence, this review aims to assist governments, humanitarian organizations, and global health stakeholders in formulating and executing maternal health policies that are both sustainable and tailored to the unique challenges of conflict-affected settings. Also, the knowledge gained from this review will support global efforts to meet Sustainable Development Goal (SDG) 3.1, which targets a reduction in maternal mortality worldwide to fewer than 70 deaths per 100,000 live births by the year 2030 (Rab et al., 2023). while addressing disparities in maternal health outcomes among populations impacted by prolonged conflict and fragility.