Strengthening Maternal Health Service Continuity in Wartime Sudan Through a Positive Peace Framework

Sudan continues to experience severe disruption of maternal health services due to prolonged armed conflict, resulting in reduced availability of antenatal care, skilled birth attendance, and emergency obstetric services. While humanitarian responses address immediate survival needs, they often fail to ensure sustained maternal care across pregnancy, childbirth, and the postnatal period. This paper examines how the Positive Peace framework informs feasible strategies to improve maternal health service access and continuity under wartime conditions in Sudan. A structured narrative review draws on peer-reviewed literature and institutional reports published between 2010 and 2024, focusing on maternal health service delivery in conflict-affected and post-conflict settings. Evidence is synthesized thematically and mapped onto the pillars of the Positive Peace framework to assess feasibility and relevance for the Sudanese context. Four themes emerge: disruption of maternal health services under insecurity, demand-side barriers and social constraints affecting care seeking, decentralized service delivery strategies effective in comparable settings, and the role of governance, equity, and information flow in sustaining service delivery. High-feasibility actions include mobile and outreach maternal health services, strengthened referral and emergency transport systems, integration of trained community-based providers, targeted financial protection mechanisms, and improved coordination between government and humanitarian actors. The findings indicate that improving maternal health during armed conflict requires approaches extending beyond emergency clinical care. Applying the Positive Peace framework supports alignment between maternal health interventions and broader social and institutional conditions necessary for sustained service delivery, offering a practical pathway to strengthen maternal health systems during conflict while supporting long-term resilience.