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Midwives as Primary Caregivers in Colombia’s Remote AreasAcross the mountainous and jungle‑covered parts of Colombia, traditional midwives—known locally as parteras—are the first point of contact for pregnant women. They offer prenatal check‑ups, assist with deliveries, and provide post‑natal support, often traveling long distances on foot or by mule to reach isolated households.They operate in regions where clinics are scarce or hours away.Their services are rooted in centuries‑old indigenous practices combined with basic medical knowledge.Community trust is built on shared language, customs, and personal relationships.Challenges Facing Traditional Birth AttendantsDespite their vital role, midwives confront several obstacles:Limited access to modern medical supplies and training.Regulatory uncertainty, as national health policies struggle to integrate informal practitioners.Economic pressures that make it difficult to sustain their work without external support.Implications for Rural Health OutcomesThe presence of midwives correlates with lower maternal and infant mortality in the areas they serve, as they can identify complications early and arrange referrals to hospitals when needed. Their culturally sensitive approach also encourages higher rates of prenatal care attendance among women who might otherwise avoid formal clinics.Future Prospects for Integrating Midwives into the Formal Health SystemPolicymakers and NGOs are exploring pathways to formalize the role of traditional midwives, including:Providing certified training programs that respect indigenous knowledge.Establishing supply chains for essential medicines and clean delivery kits.Creating referral networks that link midwives with nearby health centers.Such initiatives aim to preserve the community‑based strengths of the midwives while enhancing safety and outcomes for mothers and newborns.

US Funding Reductions Threaten Maternity Care in CAR's Vakaga ProvinceSudanese refugee women in northeastern Central African Republic (CAR) are confronting a growing danger of dying in childbirth after recent cuts to U.S. foreign assistance have weakened the limited maternity services that were already stretched thin.In the remote Vakaga province, a handful of clinics in and around the border town of Birao—supported by the United Nations Population Fund (UNFPA)—provide antenatal check‑ups, emergency obstetric care, and basic delivery services for both refugees and host‑community women. Those services depend heavily on international funding, especially contributions from the United States that pay for midwives, medicines, and essential equipment.Maternal Mortality Context and Refugee Influx NumbersTens of thousands of people have fled fighting in Sudan’s Darfur region and entered CAR, overwhelming a health system that was already fragile.CAR ranks among the countries with the highest maternal mortality rates worldwide.Recent funding reductions have forced some clinics to cut overnight staffing and outreach activities, increasing the risk that women will deliver at home without skilled assistance.Consequences for Refugee and Host CommunitiesRefugee women, many arriving while pregnant after days of walking through the bush, face multiple health threats: malnutrition, malaria, untreated infections, and a lack of prior exposure to skilled midwives. Complications such as obstructed labour, haemorrhage, and eclampsia are common and can be fatal without rapid intervention.Local women in Vakaga experience similar challenges. Poor road infrastructure, insecurity, and a shortage of ambulances mean that reaching the nearest clinic can take hours. When facilities run low on supplies or staff, families often resort to traditional birth attendants or delay seeking care until it is too late.What Future Funding Scenarios Could Mean for Maternal HealthUN and NGO officials warn that further cuts could lead to the closure of maternity wards, a reduction in trained midwives, and the scaling back of emergency referral systems. Such setbacks would reverse recent gains in encouraging facility‑based deliveries.Humanitarian agencies are urging donors to sustain—and ideally increase—support for maternal health services in CAR, arguing that the cost of maintaining midwives and basic obstetric care is modest compared with the human cost of preventable deaths. Predictable funding is essential to protect both refugee and host‑community women in one of the world’s poorest nations.