Cultural Pressure for Male Heirs Endangers Maternal Health in Congo

In Congo and across sub-Saharan Africa, cultural traditions demanding male heirs are driving women to undergo repeated pregnancies that threaten their health and lives. The pressure, rooted in patrilineal inheritance systems where sons are valued to perpetuate clan lines while daughters marry into other families, creates a cycle of unwanted childbearing that contributes to the region's devastating maternal mortality crisis.

Prosper Mbumba, a human rights activist from Congo's Luba people, exemplifies this dynamic. He and his wife had four daughters before finally conceiving two sons, with Mbumba describing the birth of his first son as making him feel "a little satisfied." His experience reflects a broader cultural phenomenon where having only daughters is viewed as shameful. According to the UN Population Fund, roughly 29 percent of Congolese women of reproductive age report an unmet need for family planning services, whether to space births or stop childbearing altogether. Yet men frequently block their partners from accessing contraception, asserting their right to make reproductive decisions.

The consequences are dire. Sub-Saharan Africa accounts for 70 percent of global maternal deaths, with approximately 180,000 pregnancy deaths recorded annually across the continent, despite a declining overall trend. Congo itself has one of the world's highest fertility rates at 5.9 children per woman, driven by cultural preferences for early marriage and large families combined with inadequate access to contraception. The lack of medical infrastructure—including insufficient healthcare workers and limited resources for managing complicated births, particularly in rural areas—compounds these risks.

Physician Patrick Djemo, who leads MSI Reproductive Choices in Congo, noted that "a lot of pressure is exerted on couples, and, as you know, mostly it is the woman who is blamed for giving birth to a girl." Women often internalize these expectations, accepting repeated pregnancies as culturally justified despite health dangers. The Congolese government has attempted to address the crisis through a five-year strategic plan aiming to provide universal access to family planning services by 2026, but implementation remains challenging in a country the size of Western Europe with poor infrastructure and ongoing armed conflict in the east.

Completing the picture is a significant policy shift: major international donors, particularly the United States under the Trump administration, are cutting assistance that supports maternal and child health initiatives across the continent. This funding withdrawal threatens to further undermine efforts to expand contraception access and improve maternal healthcare delivery at a critical moment.