Through early antenatal care and improved hospital access, Rwanda has made remarkable progress. Hospital deliveries now account for 95% of births, maternal mortality has dropped from 1,070 per 100,000 live births in 2000 to 203, and newborn mortality is down to 19 per 1,000.
Infant and under-five mortality rates are 33 and 45 per 1,000, respectively.
By 2030, Rwanda aims to reduce maternal deaths to 126 per 100,000 births, or even 70. This progress is driven by more than 140 medical specialists nationwide, with over 200 expected in the next four years, thanks to training in teaching hospitals.
One of the key figures in this transformation is Dr. Emmanuel Nshimiyumuremyi, an obstetrician-gynecologist and maternal-fetal medicine specialist trained in Rwanda, the UK, Vietnam, and the U.S. His field focuses on managing high-risk pregnancies and fetal conditions.
"Some risks, such as pregnancy-induced hypertension, can now be identified as early as the third month," Dr. Nshimiyumuremyi explained. "When caught early, we can prevent up to 90% of such cases. Out of ten at-risk women, nine can avoid complications through timely medication."
This condition, one of the top three causes of maternal death, can damage the mother's kidneys or lead to brain hemorrhage, sometimes resulting in the death of both mother and child.
First fetal blood transfusion in Rwanda
In a groundbreaking procedure, Dr. Nshimiyumuremyi and his team at the University Teaching Hospital of Kigali (CHUK) recently performed Rwanda's first fetal blood transfusion. A pregnant woman from a district hospital presented with an unusually growing belly.
At CHUK, doctors discovered not only excess amniotic fluid but also severe fetal anemia caused by Rh incompatibility, a condition where the mother's immune system attacks the baby's red blood cells.
"We began transfusions at six months and delivered at nine," Dr. Nshimiyumuremyi said. "The baby was treated in neonatal care and survived, something people thought was only possible abroad."
The success was made possible by skills acquired through training, and availability of specialized tools that can support over 100 such patients.
This milestone was also backed by AI-powered ultrasound machines that can detect fetal abnormalities in real time, devices recently introduced to CHUK.
'We once dreamed of this technology when training abroad. Now it's here in Rwanda, and it's changing everything,' he said.
Blood quality also posed a challenge. Fetal transfusions require small, high-quality blood units rich in red cells. Dr. Nshimiyumuremyi worked with the Rwanda Biomedical Centre's blood division to increase red cell concentration from 40% to 70%, making the transfusion possible.
Genetic testing and fetal surgery
Looking ahead, Dr. Nshimiyumuremyi envisions the launch of a genetic testing laboratory capable of diagnosing inherited disorders like Trisomy 21 (Down syndrome) before birth. Current machines can detect indicators, but the goal is to collect fetal samples and analyze them for early, accurate diagnoses.
The project includes acquiring microarray technology, which detects cellular mutations and helps guide future pregnancies with data-driven decisions.
Another major innovation under consideration is fetal surgery, particularly for twins sharing a placenta. Known as monochorionic twins, they risk unequal blood flow, a potentially fatal condition for one or both babies.
"We can detect this at four months and plan to use laser technology to separate shared blood vessels," he said. "If we succeed, Rwanda could be among the first African nations to offer this procedure."
The process involves using a camera and laser through a small incision to separate the connecting vessels without harming the babies or the mother, a method successfully practiced in countries like Vietnam.
Remaining challenges and hope ahead
Despite remarkable progress, Dr. Nshimiyumuremyi observes that challenges remain. Rwanda needs more specialists in maternal-fetal medicine (CHUK currently has just one, but needs at least five), and the public still lacks awareness of high-risk pregnancy conditions.
Other risks include pregnancy-induced hypertension, postpartum bleeding, and surgical infections.
But the momentum is clear. Rwanda is no longer simply managing pregnancies, it is diagnosing, treating, and protecting life before it even begins.
IGIHE
