LUSAKA — In Zambia, whether a woman survives childbirth can still come down to three moments - the decision to seek care, the journey to reach it, and the quality of care she receives when she arrives.
Health specialists call these the Three Delays, and they remain as one of the clearest ways to understand why preventable maternal deaths still occur and how they can be stopped.
The national picture shows both progress and urgency: Zambia’s maternal mortality ratio stands at 187 deaths per 100,000 live births, the total fertility rate is 4.0 children per woman, and 55 percent of married women use contraception. Yet vulnerability remains high, with 28 percent teenage pregnancy and 36 percent of women aged 15-49 reporting physical violence, all of which increase maternal risk. Recent survey trends also show major gains in coverage, with over 90 percent of births now taking place in health facilities and attended by a skilled provider, a critical foundation for survival.
Across the country, the Government of Zambia, with support from the United Nations Population Fund (UNFPA) and partners through the SafeBirth Africa initiative, co-funded by the European Union and implemented with Unitaid and Jhpiego, is working to close these gaps by strengthening the ecosystem around pregnancy and childbirth, from referral systems and midwifery skills to emergency obstetric care and life-saving medicines. SafeBirth Africa supports countries to scale up World Health Organization (WHO)-recommended maternal health medicines and devices, strengthen Emergency Obstetric and Newborn Care, and reinforce midwifery and supply systems so women receive timely treatment, especially for postpartum hemorrhage, one of the leading causes of maternal death.
From readiness to survival
For Bastana Mwanza, 28, those system investments made the difference during a national health emergency.
In early 2024, as Zambia battled a severe cholera outbreak, she went into labor while already seriously ill. Complications escalated quickly. In many communities, this is where the first delay takes hold, uncertainty about danger signs, cost fears, or hesitation at home. But strengthened community referral awareness meant her family recognized the risk and acted fast. She was taken to a facility without waiting for the situation to worsen.
The next risk is often distance and access. During the outbreak, maternity services in key facilities were deliberately protected so obstetric emergencies could still be managed safely even as epidemic units filled. That separation, outbreak response on one side, maternal care on the other, helped ensure continuity of skilled care.
The final delay, quality of treatment on arrival, is where SafeBirth Africa investments are most visible. Facilities are strengthening emergency obstetric and newborn care readiness, improving postpartum hemorrhage detection and treatment, and equipping providers with calibrated blood-loss measurement tools, updated treatment bundles, and WHO-recommended medicines. Simulation drills and clinical mentoring are helping turn guidelines into a practiced response.
Safe birth is not one intervention, it is a chain of readiness, where skills, supplies, and systems must hold at the same time.
Midwives sit at the center of that chain. Zambia continues to invest in midwifery training, mentorship, and professional strengthening so frontline providers can manage both routine deliveries and sudden complications. Maternal and perinatal death surveillance and response systems, meaning structured national reviews of why mothers and newborns die, are also helping target gaps more precisely.
Financing reforms are reinforcing service delivery. A Government-UNFPA Compact of Commitment on reproductive health commodities has mobilized more than US$11 million for procurement through national systems, with additional matched funding unlocking multi-year supply, improving availability of essential maternal health medicines in public facilities and reducing the risk of stock-outs at the point of care.
Safe birth is not secured by one programme or one product. It is secured when the system holds, when a woman is informed, transported, received, treated, and followed up with skill and dignity. Zambia’s current push is about making that chain reliable, closing each delay, strengthening each layer, and ensuring that when childbirth turns dangerous, the response is already in place.
