Abstract
BACKGROUND: Since April 2023, the conflict in Sudan has profoundly impacted the healthcare system, particularly maternal health services. This study examines women's experiences accessing and receiving intrapartum care at healthcare facilities during the conflict's acute phase in Khartoum, highlighting the challenges they faced and the adjustments they made to obtain care. METHODS: This qualitative study employed remote semi-structured interviews with nine women who gave birth in Khartoum between April and October 2023. The interviews were audio-recorded and transcribed verbatim. The authors used thematic analysis to analyse the data. RESULTS: The findings indicated an unprecedented, rapid decline in maternal health services in Khartoum, with conditions deteriorating as the conflict escalated. Major challenges included widespread facility closures, significant shortages of medical supplies and healthcare professionals, compromised security, and violations of respectful care practices. Women who delivered later in the conflict encountered greater difficulties compared to those who gave birth in the earlier stages. Despite the severe disruption of woman-centred care, women exhibited immense resilience through self-advocacy and exploring alternative options. Community-based midwifery care emerged as a viable model, presenting potential avenues for keeping access to maternal health services during a crisis. CONCLUSIONS: This study underscores the urgent need to bolster the resilience of maternal health services in conflict zones. Recommendations include developing robust emergency preparedness plans, creating sustainable supply chains, supporting healthcare providers, and exploring innovative service delivery models like mHealth solutions and community-based care. These findings offer valuable insights for humanitarian responses and the strengthening of health systems in conflict-affected regions.