In northern Ghana‘s Upper East Region, the road to giving birth can be treacherous. Women in labour have to cross rivers by canoe to give birth, or walk for hours along flooded clay paths, doubled over with contractions, clutching plastic bags filled with baby clothes and sanitary pads. Sometimes they ride bicycles because no motorbike can get through the mud and often they do not make it to the clinic at all.
Dorcas Azongo, 29, gave birth to her twins after crossing two rivers at night while in labour, riding part of the way on her husband’s motorcycle. She says: “When we reached the [first] river, it was difficult to cross because during the rainy season it is always full… I was in too much pain to speak”. She could not sit probably on the motorcycle for the same reason.
By the time she reached Bongo Hospital, exhausted and in agony, it was too late to get her inside. “I delivered in the yard – as the babies were already coming, the [midwives] could not carry me inside. They helped me deliver there, then took me inside, cleaned me up and dressed me and the babies.”
It was not her first dangerous delivery, after her first child was born in the yard after her husband failed to find transport in time. For her second, relatives balanced her on the back of a bicycle and pushed her for nearly an hour to another clinic. “I feel bad and a bit down sometimes when I sit and think back on how difficult my deliveries were. Sometimes I feel like giving up and tell myself I never want to give birth again because of all that pain,” Dorcas says.
“If they delay and reach the riverside and cannot cross, we sometimes have to deliver them there”, Rejina Abane, a midwife working across remote communities in Bongo district explains. “Delivering on the ground is not good. There is risk of infection, and the place is not prepared. Cutting the cord and other procedures are not safe there, especially when it has rained and the ground is muddy.”
In villages like Beo Tankoo and Atampiisi, close to Ghana’s border with Burkina Faso, childbirth is shaped by water. In the dry season, streams disappear and boreholes fail. In the rains, rivers swell and cut entire communities off from hospitals and maternity wards, leaving pregnant women stranded on riverbanks in the middle of labour, waiting for canoe operators to return in the dark.
A fall in aid
Inside the health centres themselves, the conditions are scarcely safer. Women arrive carrying their own water from home because clinics have none, midwives fetch buckets from distant boreholes before they can begin work and patients needing urine tests squat behind buildings because there are no toilets.
open image in galleryIn neighbouring Atampiisi, Sophia Atule, 31, is eight months pregnant with her fifth child, waking before dawn each morning to sweep, cook and queue for water at the community borehole, often spending close to two hours waiting. She knows the local clinic has no midwife and no water, and she knows the rivers well enough to have already planned the long route round to Bongo Hospital for when labour begins “If you are in labour as a pregnant woman, the rivers are too dangerous to cross during the rainy season. When it’s rainy season and you have to go the long way, some of the women might end up delivering on their way to the facility,” Sophia says.
The crisis comes as aid agencies warn that years of progress on maternal health across parts of Africa are becoming increasingly fragile as deep cuts begin to bite. In January 2025, Donald Trump functionally dismantled the United States Agency for International Development (USAID) with more than 80 per cent of its programmes stopped or terminated – that has been followed by cuts from the UK, Germany and other nations.
Across this period, the UN Population Fund has recorded sharp drops in procurement of essential supplies across sub-Saharan Africa and organisations that relied on US bilateral funding to run community health programmes are operating on emergency reserves or not operating at all. WaterAid staff working in Ghana say clinics in Bongo district still lack the most basic water, sanitation and hygiene infrastructure needed for safe childbirth and the money that was already too thin is getting thinner.
open image in galleryBoth health centres in Beo Tankoo and Atampiisi have no running water and no borehole, after drilling attempts failed because fluoride levels in the groundwater were too high, meaning pregnant women are told to bring water from home when they come for antenatal appointments while health staff queue at a community borehole 200 metres to 300 metres away. For Rejina the midwife, it means starting work 90 minutes to two hours late. “That I use to fetch water I could use it to attend to 3 or 4 people but the women are also delayed because they have to stand and wait for me”, she says.
When there is none at all, she uses hand sanitiser between palpations, which she knows is not the right protocol. She says: “If I don’t wash my hands and continue examining women one after another, I risk spreading infections. In the end, the women may go home, develop infections and then have to go to the hospital.”
‘Making a difficult situation worse’
New research by development economist Guy Hutton for WaterAid puts Ghana’s annual maternal sepsis burden at 101,645 cases and 149 deaths and finds that improved water, sanitation and hygiene in healthcare facilities could cut both figures roughly in half. The cost per sepsis case is estimated at $154 (£114) and across more than 100,000 cases annually that amounts to $15.7 million (£11.7m), of which $7.9 million (£5.9m) could be directly avoided with better WASH provision. Nationally, 98 per cent of health centre births in Ghana take place without basic sanitation, and a third happen without any water access at all.
open image in gallery“Women are being forced to risk their lives in labour, crossing flooded rivers just to reach basic care. No woman should have to endure this to give birth safely,” says Ewurabena Yanyi-Akofur, WaterAid Ghana’s country director. “This crisis highlights how essential water, sanitation and hygiene are to maternal health and how climate change is making an already difficult situation worse. I see every day how women are disproportionately affected. It is deeply disheartening that running water in a healthcare facility is still considered a luxury when it should be the standard.”
WaterAid and local authorities are attempting to change this through a project called Good Health Begins Here, which aims to install mechanised solar-powered water systems, storage tanks, toilets and incinerators at clinics including Beo Tankoo and Atampiisi – infrastructure designed to handle the fluoride problem that defeated previous drilling attempts and eventually to make a permanent midwife posting viable.
The sanitation work has started and the water is not in yet, but Fatima Mumuni, an engineering technician with the Bongo district assembly, says the ambition goes beyond a new borehole: “In these communities, people usually get water from boreholes within the community and bring it to the health centres. If somebody is about to give birth, they have to carry their water from their house.” She hopes the new infrastructure will change that.
For now, the rivers still rise when the rains come, women still arrive at clinics carrying jerrycans alongside their hospital bags and midwives are still spending the first hours of their working day searching for enough water to wash their hands.
“Change is possible,” Yanyi-Akofur says. “Through WaterAid’s Time to Deliver campaign, we are standing with women, health workers and calling on governments to prioritise water, sanitation and hygiene in healthcare for every woman, every birth and every future.”
To sign the WaterAid Time to Deliver petition please click here
This article has been produced as part of The Independent’s Rethinking Global Aid project