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The stage of obstetric transition in South Sudan

South Sudan’s maternal mortality rate in 2015 was fifth highest in the world. According to World Bank data based on modelled estimates, South Sudan’s maternal mortality rate has fallen from 1,730 deaths per 100,000 live births in 1990 to 789 deaths per 100,000 live births in 2015. Even with this improvement, South Sudan’s maternal mortality rate places the coun- try in the second highest of the five stages of Obstetric Transition identified by the WHO.2 The authors note that for Stages I and II, the critical issue is access to care.

In general, these are countries substantially lacking basic infrastructure (such as roads, transportation and health facilities), very low levels of education (particularly female literacy), weak health systems, severe shortages of skilled birth attendants and low capacity to deliver essential life-saving interventions. In this context, poor quality of care functions as a deterrent for generating demand for health services. In countries in these stages, focus should be directed to developing the basic infrastructure (including human resources) and implementing maternal-mortality primary prevention measures... As the minimal infrastructure is developed, health services should strive to deliver quality care in order to become a sensible alternative to pregnant women (demand generation) (Souza et al 2014: 2-3).

Other compounding factors that result in a high death rate in the local population are the very high incidence of malaria, and very high rates of HIV/AIDS and other infectious diseases such as tuberculosis and leprosy.

Two other relevant indicators are (1) the number of infants dying before reaching one year of age, per 1,000 live births in a given year and (2) the number of children who die before reaching age five per 1,000 live births.

The infant mortality rate for South Sudan in 2016 is 59 per 1,000 live births (median estimate). The under five child mortality rate for South Sudan in 2016 is estimated to be 91 per 1,000 births (median estimate). South Sudan on both indicators ranks separately 13th highest in the world.