This week’s RAISE/IAWG literature review begins below with an article presenting a youth-led referral network designed to improve access to reproductive health and safe abortion services in conflict-affected communities in the Democratic Republic of Congo. The second article examines the application of an adapted maternal death surveillance and review system during acute humanitarian responses in Sudan. The third article presents a qualitative study exploring midwives’ lived experiences of providing childbirth care amid war in Gaza.
If you have trouble accessing any of the articles, please feel free to contact Athena Ghubril at Mailman School of Public Health, Columbia University, NYC, USA at: raise@cumc.columbia.edu
Article 1
The Mashujaa Network: youth-driven resilience for reproductive health and safe abortion in conflict-affected communities
by Amos M Makelele, Mike Mpoyi , Jean-Claude Mulunda, Nadia Lobo Jive , Michee Kanda Sanza, Beniel Ulrich Agossou and Simon Binezero Mambo
Published in: Frontiers in Reproductive Health
DOI: https://doi.org/10.3389/frph.2026.1814179
Abstract
Sexual and reproductive health (SRH) and rights are fundamental to individual well-being and development. Yet, significant global gaps in access to SRH information and services threaten the lives and health of millions of individuals and their families. Protecting the health of vulnerable populations in conflict zones is a critical public health priority. There is a significant lack of evidence on effective approaches to delivering comprehensive sexual and reproductive health (SRH) interventions in these settings. In the Democratic Republic of Congo (DRC), where unsafe abortion is a leading cause of maternal mortality, the Mashujaa Youth Referral Network was developed as an innovative, youth-led model to bridge this gap. By training young individuals as Mashujaa Champions, the network provides a trusted, community-based pathway for advocacy, peer education, and direct referral to safe abortion and other essential SRH services. This participatory approach demonstrates the profound potential of locally led initiatives to not only expand access to life-saving care and reduce stigma, but also to empower young people to become agents of change. Scaling this proven framework offers a sustainable solution for strengthening SRH resilience and reducing preventable maternal deaths in humanitarian contexts.
Article 2
The application of maternal death surveillance and review in acute humanitarian responses
by Kate Charlton, Gillian Burkhard, Noortje Rijnberg, Ruth Kauffman, Ali Almohommed, Maura Daly, Huda Abdalla Alhilo, Malaz Hamid Ali Hamid, Roa Abdalla Osman Abo-Elhassan, Khalid Abbaker Adam Ali, Eltahir Adam Eltahir, Faisal Abbas Ibrahim Ahmed, Felipe Van Braak, Jethro Guerina Adingue, Tom Casey, Kyle McNally, and Benjamin Black
Published in: O&G Open Journal
DOI: 10.1097/og9.0000000000000178
Abstract
Sexual and reproductive health needs and rights continue to be not only unmet but actively deprioritized in humanitarian settings. This disproportionately exacerbates inequities in maternal and newborn health, leading to increased maternal morbidity and mortality. Poor maternal health outcomes often go unnoticed in emergency settings in which competing priorities mean that monitoring maternal morbidity and mortality is frequently excluded from the initial response. The World Health Organization’s MPDSR (Maternal Perinatal Death Surveillance and Review) system is a widely accepted standard for monitoring maternal morbidity and mortality; however, it is not recommended for the acute phase—defined as the first 6 months—of a humanitarian crisis because of feasibility constraints. This highlights the need for adapted approaches for surveillance and response during acute humanitarian crises. As part of its focus on reproductive health in humanitarian settings, Médecins Sans Frontières adapted the MPDSR tool for Tigray, Ethiopia, in 2020 and has since implemented the tool in Sudan after war erupted in April 2023. Although doing so has involved challenges, the results have been instrumental in informing programming, even during complex emergencies. This clinical perspective describes the Médecins Sans Frontières experience implementing a R-MDSR (Rapid Maternal Death Surveillance and Review) system in Sudan during the early stages of the escalating 2023 crisis. This commentary offers a reflective and, at times, critical account of the implementation of R-MDSR and demonstrates the feasibility and role of the tool in driving timely, action-oriented interventions to improve maternal health in fragile and conflict-affected settings.
Article 3
Birth in shelters: Midwives’ lived experiences in providing childbirth care amidst war in Gaza
by Sahar Hassan, Suha Baloushah, Berit Mortensen
Published in: PLOS One Journal
DOI: https://doi.org/10.1371/journal.pone.0339551
Abstract
Background: The warfare against the Gaza Strip in the occupied Palestinian territory, starting in October 2023, caused massive destruction of infrastructure, including homes and hospitals. Within two years (October 2023 to October 2025), most of the 2.1 million inhabitants were displaced, and more than 69,500 people were directly killed, of whom more than 70% were women and children. To enhance preparedness in maternal care during war, it is important to understand how midwives respond to emergencies in conflict zones. This study seeks to explore the experiences of midwives in delivering childbirth care to women in Gaza within shelters, tents, and amidst the rubble during wartime.
Materials and methods: We employed a descriptive qualitative phenomenological design. We used a purposeful snowball sampling approach to identify midwives who had assisted women in giving birth in shelters or tents during the war. Face-to-face in-depth interviews were conducted with nine midwives between January and April 2025, and underwent reflexive thematic analysis.
Results: An overarching theme was identified: “Midwives torn between fear and professional compassion while struggling for humanity in a ruthless war”. Three additional themes were developed: “Unprotected in ruthless warfare”, “Professional role and contradictive emotions”, and “Challenges and potentials for midwives during war and emergencies”.
Conclusions: The study recommends the development of clear preparedness policies aligned with midwives’ scope of practice that support their professional role when caring for pregnant women in war, emergency, and humanitarian contexts. Given the volatile context of the opt, Palestinian midwives should be actively involved in preparedness strategies for emergency response. They need guidance, support, necessary supplies, connection to backup resources, and training to assist births safely outside hospital settings.